Leidel Bernd A, Kirchhoff Chlodwig, Bogner Viktoria, Stegmaier Julia, Mutschler Wolf, Kanz Karl-Georg, Braunstein Volker
Department of Emergency Medicine, Charité - University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.
Patient Saf Surg. 2009 Oct 8;3(1):24. doi: 10.1186/1754-9493-3-24.
For patients' safety reasons, current American Heart Association and European Resuscitation Council guidelines recommend intraosseous (IO) vascular access as an alternative in cases of emergency, if prompt venous catheterization is impossible. The purpose of this study was to compare the IO access as a bridging procedure versus central venous catheterization (CVC) for in-hospital adult emergency patients under resuscitation with impossible peripheral intravenous (IV) access. We hypothesised, that CVC is faster and more efficacious compared to IO access.
A prospective observational study comparing success rates and procedure times of IO access (EZ-IO, Vidacare Corporation) versus CVC in adult (>/=18 years of age) patients under trauma and medical resuscitation admitted to our emergency department with impossible peripheral IV catheterization was conducted. Procedure time was defined from preparation and insertion of vascular access type until first drug or infusion solution administration. Success rate on first attempt and procedure time for each access route was evaluated and statistically tested.
Ten consecutive adult patients under resuscitation, each receiving IO access and CVC, were analyzed. IO access was performed with 10 tibial or humeral insertions, CVC in 10 internal jugular or subclavian veins. The success rate on first attempt was 90% for IO insertion versus 60% for CVC. Mean procedure time was significantly lower for IO cannulation (2.3 min +/- 0.8) compared to CVC (9.9 min +/- 3.7) (p < 0.001). As for complications, failure of IO access was observed in one patient, while two or more attempts of CVC were necessary in four patients. No other relevant complications, like infection, bleeding or pneumothorax were observed.
Preliminary data demonstrate that IO access is a reliable bridging method to gain vascular access for in-hospital adult emergency patients under trauma or medical resuscitation with impossible peripheral IV access. Furthermore, IO cannulation requires significantly less time to enable administration of drugs or infusion solutions compared to CVC. Because CVC was slower and less efficacious, IO access may improve the safety of adult patients under resuscitation in the emergency department.
出于患者安全考虑，美国心脏协会和欧洲复苏委员会现行指南建议，在无法迅速进行静脉置管的紧急情况下，骨内（IO）血管通路可作为一种替代方法。本研究的目的是比较在院内成人急诊复苏患者中，当外周静脉（IV）通路无法建立时，IO通路作为一种过渡性操作与中心静脉置管（CVC）的效果。我们假设，与IO通路相比，CVC更快且更有效。
进行了一项前瞻性观察性研究，比较在我院急诊科接受创伤和医疗复苏且外周IV置管无法进行的成年（≥18岁）患者中，IO通路（EZ-IO，Vidacare公司）与CVC的成功率和操作时间。操作时间定义为从准备和插入血管通路类型到首次给药或输注溶液的时间。评估并统计测试了每种通路首次尝试的成功率和操作时间。
对连续10例接受复苏的成年患者进行了分析，每位患者均接受了IO通路和CVC。IO通路进行了10次胫骨或肱骨穿刺，CVC在10例颈内静脉或锁骨下静脉进行。IO穿刺首次尝试的成功率为90%，而CVC为60%。IO置管的平均操作时间（2.3分钟±0.8）显著低于CVC（9.9分钟±3.7）（p<0.001）。至于并发症，1例患者IO通路失败，4例患者需要进行两次或更多次CVC尝试。未观察到其他相关并发症，如感染、出血或气胸。
初步数据表明，对于创伤或医疗复苏且外周IV通路无法建立的院内成人急诊患者，IO通路是一种可靠的获取血管通路的过渡方法。此外，与CVC相比，IO置管所需时间显著更少，能够更快给药或输注溶液。由于CVC较慢且效果较差，IO通路可能会提高急诊科复苏成年患者的安全性。
