Voigt Jeffrey, Waltzman Mark, Lottenberg Lawrence
Medical Device Consultants of Ridgewood, Ridgewood, NJ, USA.
Pediatr Emerg Care. 2012 Feb;28(2):185-99. doi: 10.1097/PEC.0b013e3182449edc.
Intraosseous (IO) vascular access is a viable primary alternative in patients requiring emergent vascular access in the hospital emergency department (ED) (eg, resuscitation, shock/septic shock) but is underutilized.
This review has 3 objectives: (1) review the evidence supporting the use of IO access; (2) determine the utilization of IO access as described in the literature; and (3) assess the level of specialty society support.
Electronic and hand searches were undertaken to identify relevant articles. English-language-only articles were identified. The Cochrane Review methodology along with data forms were used to collect and review data. The evidence evaluation process of the international consensus on emergency cardiovascular care was used to assess the evidence. Studies were combined where meta-analyses could be performed.
In levels 2 to 5 studies, IO access performed better versus alternative access methods on the end points of time to access and successful access. Complications appeared to be comparable to other venous access methods. Randomized controlled trials are lacking. Newer IO access technologies appear to do a better job of gaining successful access more quickly. Intraosseous access is underutilized in the ED because of lack of awareness, lack of guidelines/indications, proper training, and a lack of proper equipment.
Recommendations/guidelines from physician specialty societies involved in the ED setting are also lacking. Underutilization exists despite recommendations for IO access use from a number of important medical associations peripherally involved in the ED such as the American Academy of Pediatrics. To encourage the IO approach, IO product champions (as both supporter and user) in the ED are needed for prioritizing and assigning IO access use when warranted. In addition, specialty societies directly involved in emergent hospital care should develop clinical guidelines for IO use.
骨内（IO）血管通路是医院急诊科（ED）中需要紧急血管通路的患者（如复苏、休克/脓毒性休克）可行的主要替代方法，但未得到充分利用。
本综述有3个目的：（1）回顾支持使用IO通路的证据；（2）确定文献中描述的IO通路的使用情况；（3）评估专业学会的支持程度。
进行电子检索和手工检索以识别相关文章。仅纳入英文文章。采用Cochrane综述方法及数据表格收集和回顾数据。使用国际急诊心血管护理共识的证据评估流程评估证据。在可进行荟萃分析时合并研究。
在2至5级研究中，在建立通路时间和成功建立通路的终点方面，IO通路比其他替代通路方法表现更好。并发症似乎与其他静脉通路方法相当。缺乏随机对照试验。更新的IO通路技术似乎能更快更好地成功建立通路。由于缺乏认识、缺乏指南/适应症、缺乏适当培训以及缺乏适当设备，骨内通路在急诊科未得到充分利用。
在急诊科工作的医师专业学会也缺乏相关建议/指南。尽管一些与急诊科间接相关的重要医学协会（如美国儿科学会）推荐使用IO通路，但仍存在利用不足的情况。为鼓励采用IO方法，急诊科需要有IO产品倡导者（既是支持者又是使用者），以便在必要时优先考虑并安排IO通路的使用。此外，直接参与医院急诊护理的专业学会应制定IO使用的临床指南。
