School of Primary Health Care, Monash University-Peninsula Campus, Frankston, Victoria, Australia.
Prehosp Disaster Med. 2012 Oct;27(5):468-72. doi: 10.1017/S1049023X12001124. Epub 2012 Aug 9.
Although the majority of Australian intensive care paramedics use the manual intraosseous infusion technique (MAN-IO), several other semiautomatic devices now are available, such as the bone injection gun (BIG) and the semiautomatic intraosseous infusion system (EZ-IO). Given the choice of devices now available, questions have been raised regarding success rates, accuracy, decay of skills, and adverse events.
Review the literature regarding the use of intraosseous (IO) devices in the prehospital setting.
Selected electronic databases (Medline, Embase, and CINAHL) were searched, and a hand search was conducted for grey-literature that included studies from the commencement of the process to the end of May 2010. Inclusion criteria were any study reporting intraosseous insertion and/or infusion (adult and pediatric) by paramedics in the prehospital setting.
The search located 2,100 articles; 20 articles met the inclusion criteria. The review also noted that use of IO access (regardless of technique) offers a safe and simple method for gaining access to the patients' vascular system. A number of studies found that the use of semiautomatic devices offers better and faster intraosseous access compared with the use of manual devices, and also were associated with fewer complications. The findings also suggest that the use of semiautomatic devices can reduce insertion times and the number of insertion attempts when contrasted with the use of manual insertion techniques. Despite these findings, statistically no specific IO device has proven clinical superiority.
While manual IO techniques currently are used by the majority of Australian paramedics, the currently available evidence suggests that semiautomatic devices are more effective. Further research, including cost-benefit analyses, is required at a national level to examine skill acquisition, adverse effects, and whether comparative devices offer clinically significant advantages.
尽管大多数澳大利亚重症监护急救医护人员使用手动骨髓内输液技术（MAN-IO），但现在还有其他几种半自动设备可供使用，例如骨内注射枪（BIG）和半自动骨髓内输液系统（EZ-IO）。鉴于现在可用的设备种类繁多，人们对成功率、准确性、技能衰减和不良事件提出了疑问。
回顾有关在院前环境中使用骨髓内（IO）设备的文献。
选择了电子数据库（Medline、Embase 和 CINAHL）进行搜索，并对包括从开始到 2010 年 5 月底的研究在内的灰色文献进行了手工搜索。纳入标准是任何报告由急救医护人员在院前环境中进行骨髓内插入和/或输注（成人和儿科）的研究。
搜索共找到 2100 篇文章；20 篇文章符合纳入标准。该综述还指出，IO 通路（无论技术如何）的使用为获得患者血管系统的通路提供了一种安全而简单的方法。许多研究发现，与手动设备相比，半自动设备提供了更好、更快的骨髓内通路，并且与更少的并发症相关。研究结果还表明，与手动插入技术相比，半自动设备的使用可以减少插入时间和插入次数。尽管有这些发现，但从统计学上看，没有特定的 IO 设备已被证明具有临床优势。
尽管手动 IO 技术目前被大多数澳大利亚急救医护人员使用，但现有证据表明半自动设备更有效。需要在国家层面进行进一步的研究，包括成本效益分析，以检查技能习得、不良影响以及比较设备是否具有临床显著优势。
