Schwartz Dagan, Amir Lisa, Dichter Reuven, Figenberg Zvi
MDA Medical Division, Tel-Aviv, Israel.
J Trauma. 2008 Mar;64(3):650-4; discussion 654-5. doi: 10.1097/TA.0b013e31814db2a6.
Provide evidence of success rate and limitations of the prehospital use of a powered device for intraosseous (IO) bone infusion, the bone injection gun (BIG) for critical patients in whom peripheral intravenous (IV) access cannot be readily obtained.
This prospective study included all reports regarding the use of BIG in our national EMS during the study period. The BIG is a FDA and Israeli Health ministry approved device for IO cannulation. Starting April 2000, a new version was introduced to all ALS units. Simultaneously, our medical protocols were updated to include its use and mandatory reporting was initiated. Successful insertion was defined as "obtaining a good fluid flow through the needle without evidence of extravasation". This article presents an analysis of the data collected during this period.
From May 2000 to June 2004, 189 patient encounters in which the BIG was employed met inclusion criteria and comprised the study group. Successful insertion on first attempt was achieved in 172 patients (91.0%). In two additional patients, a second attempt was successful. Forty-seven of the patients were below the age of 18 years (24.9%). One hundred ten patients (58.2%) were over 60 years of age. One hundred thirty-three were found without a palpable pulse (70.4%), and only 18 were found with a Glasgow coma scale of 9 or above. The cause was traumatic in 34 patients (18.0%).
The BIG provides an effective alternative IV access for critical patients in whom a peripheral IV line cannot be readily obtained in the prehospital setting.
对于难以迅速建立外周静脉通路的危重症患者，提供院前使用动力驱动的骨髓腔内（IO）骨内输液装置——骨注射枪（BIG）的成功率及局限性的证据。
这项前瞻性研究纳入了研究期间我国急救医疗服务（EMS）中所有关于使用BIG的报告。BIG是一种经美国食品药品监督管理局（FDA）和以色列卫生部批准用于骨髓腔内插管的装置。从2000年4月起，向所有高级生命支持（ALS）单位引入了新版本。同时，我们的医疗协议进行了更新，纳入了其使用方法，并开始要求强制报告。成功插入定义为“通过针头有良好的液体流动且无外渗迹象”。本文对在此期间收集的数据进行了分析。
从2000年5月至2004年6月，189例使用BIG的患者符合纳入标准，组成了研究组。172例患者（91.0%）首次尝试插入成功。另外2例患者第二次尝试成功。47例患者年龄在18岁以下（24.9%）。110例患者（58.2%）年龄超过60岁。133例患者被发现无脉搏（70.4%），只有18例患者格拉斯哥昏迷量表评分在9分或以上。34例患者（18.0%）病因是创伤性的。
对于在院前环境中难以迅速建立外周静脉通路的危重症患者，BIG提供了一种有效的替代静脉通路。
