Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.
Scand J Trauma Resusc Emerg Med. 2010 Oct 7;18:52. doi: 10.1186/1757-7241-18-52.
Intraosseous access (IO) is a method for providing vascular access in out-of-hospital resuscitation of critically ill and injured patients when traditional intravenous access is difficult or impossible. Different intraosseous techniques have been used by our Helicopter Emergency Medical Services (HEMS) since 2003. Few articles document IO use by HEMS physicians. The aim of this study was to evaluate the use of intraosseous access in pre-hospital emergency situations handled by our HEMS.
We reviewed all medical records from the period May 2003 to April 2010, and compared three different techniques: Bone Injection Gun (B.I.G® - Waismed), manual bone marrow aspiration needle (Inter V - Medical Device Technologies) and EZ-IO® (Vidacare), used on both adults and paediatric patients.
During this seven-year period, 78 insertion attempts were made on 70 patients. Overall success rates were 50% using the manual needle, 55% using the Bone Injection Gun, and 96% using the EZ-IO®. Rates of success on first attempt were significantly higher using the EZ-IO® compared to the manual needle/Bone Injection Gun (p < 0.01/p < 0.001). Fifteen failures were due to insertion-related problems (19.2%), with four technical problems (5.1%) and three extravasations (3.8%) being the most frequent causes. Intraosseous access was primarily used in connection with 53 patients in cardiac arrest (75.7%), including traumatic arrest, drowning and SIDS. Other diagnoses were seven patients with multi-trauma (10.0%), five with seizures/epilepsy (7.1%), three with respiratory failure (4.3%) and two others (2.9%). Nearly one third of all insertions (n = 22) were made in patients younger than two years. No cases of osteomyelitis or other serious complications were documented on the follow-up.
Newer intraosseous techniques may enable faster and more reliable vascular access, and this can lower the threshold for intraosseous access on both adult and paediatric patients in critical situations. We believe that all emergency services that handle critically ill or injured paediatric and adult patients should be familiar with intraosseous techniques.
当传统静脉通路建立困难或不可能时，经骨内置管（IO）是为危重症和创伤患者进行院外复苏时提供血管通路的一种方法。自 2003 年以来，我们的直升机医疗急救服务（HEMS）一直在使用不同的经骨内置管技术。很少有文章记录 HEMS 医生使用经骨内置管的情况。本研究旨在评估我们的 HEMS 在处理院前紧急情况下使用经骨内置管的情况。
我们回顾了 2003 年 5 月至 2010 年 4 月期间的所有病历，并比较了三种不同的技术：骨内注射枪（B.I.G®-Waismed）、手动骨髓抽吸针（Inter V-Medical Device Technologies）和 EZ-IO®（Vidacare），用于成人和儿科患者。
在这七年期间，对 70 名患者进行了 78 次插入尝试。总体成功率分别为手动针 50%、骨内注射枪 55%和 EZ-IO®96%。首次尝试的成功率使用 EZ-IO®显著高于手动针/骨内注射枪（p<0.01/p<0.001）。15 次失败是由于插入相关问题（19.2%），其中技术问题（5.1%）和外渗（3.8%）是最常见的原因。经骨内置管主要用于 53 例心搏骤停患者（75.7%），包括创伤性心搏骤停、溺水和 SIDS。其他诊断包括 7 例多发伤（10.0%）、5 例癫痫/癫痫发作（7.1%）、3 例呼吸衰竭（4.3%）和 2 例其他（2.9%）。所有插入中近三分之一（n=22）是在两岁以下的患者中进行的。在随访中没有记录到骨髓炎或其他严重并发症的病例。
新型经骨内置管技术可实现更快、更可靠的血管通路，这可以降低危急情况下成人和儿科患者进行经骨内置管的门槛。我们认为，所有处理危重症或创伤性儿科和成人患者的急救服务机构都应熟悉经骨内置管技术。
