Frascone Ralph J, Jensen Joe P, Kaye Kory, Salzman Joshua G
Regions Hospital Emergency Medical Services, Regions Hospital, St. Paul, MN 55101, USA.
Prehosp Emerg Care. 2007 Apr-Jun;11(2):164-71. doi: 10.1080/10903120701205851.
Establishing traditional intravenous (IV) access in adult trauma and medical patients can be difficult. We evaluated provider performance for obtaining intraosseous access with two FDA-approved intraosseous devices (F.A.S.T.1 and EZ-IO) in two sequential field trials.
One hundred twenty-four providers consented to participate in the first field trial evaluating the use of the F.A.S.T.1 system. Three hundred eighty-nine providers consented to participate in the second field trial, evaluating the use of the EZ-IO. Following each insertion attempt, a telephone data collection process with a member of the research team was completed. Insertion success rate and measures of provider comfort and satisfaction with each device were collected and analyzed.
One hundred seventy-eight insertions (89 F.A.S.T.1; 89 EZ-IO) were completed between February 2000 and December 2005. Sixty-four of the 89 insertions of the F.A.S.T.1 were successful, and 78 of the 89 insertions of the EZ-IO were successful (72% vs. 87%; chi2 = 6.8; p = 0.009). Providers using the F.A.S.T.1 attempted more IV insertions prior to using the IO device than the providers using the EZ-IO (2.6 vs. 2.0, p = 0.005). There were no differences in provider comfort or provider assessed device performance between the two devices (p = 0.52; p = 0.13, respectively).
In our comparison of two field trials of prehospital provider use of the F.A.S.T.1 and EZ-IO systems, more successful insertions with the EZ-IO were achieved than with the F.A.S.T.1 device. Limitations of our comparison include nonrandomization, the sequential field trial design, the potential for a learning effect, and self-reporting of data points by providers. A prospective, randomized evaluation of these devices is warranted to draw definitive conclusions about provider insertion success rate with these devices.
在成年创伤和内科患者中建立传统的静脉通路可能具有挑战性。我们在两项连续的现场试验中评估了使用两种获得美国食品药品监督管理局（FDA）批准的骨内输液装置（F.A.S.T.1和EZ-IO）时医护人员的操作表现。
124名医护人员同意参与第一项评估F.A.S.T.1系统使用情况的现场试验。389名医护人员同意参与第二项评估EZ-IO使用情况的现场试验。在每次插入尝试后，与研究团队成员通过电话完成数据收集过程。收集并分析插入成功率以及医护人员对每种装置的舒适度和满意度指标。
在2000年2月至2005年12月期间共完成了178次插入操作（89次使用F.A.S.T.1；89次使用EZ-IO）。F.A.S.T.1的89次插入操作中有64次成功，EZ-IO的89次插入操作中有78次成功（72%对87%；卡方检验=6.8；p=0.009）。使用F.A.S.T.1的医护人员在使用骨内输液装置之前尝试静脉穿刺的次数比使用EZ-IO的医护人员更多（2.6次对2.0次，p=0.005）。两种装置在医护人员的舒适度或医护人员评估的装置性能方面没有差异（分别为p=0.52；p=0.13）。
在我们对院前医护人员使用F.A.S.T.1和EZ-IO系统的两项现场试验的比较中，EZ-IO的成功插入次数比F.A.S.T.1装置更多。我们比较的局限性包括非随机化、连续的现场试验设计、存在学习效应的可能性以及医护人员对数据点的自我报告。有必要对这些装置进行前瞻性、随机评估，以便就医护人员使用这些装置的插入成功率得出明确结论。
