Helm M, Schlechtriemen T, Haunstein B, Gäßler M, Lampl L, Braun J
Klinik für Anästhesiologie & Intensivmedizin - Sektion Notfallmedizin, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland,
Anaesthesist. 2013 Dec;62(12):981-7. doi: 10.1007/s00101-013-2262-y. Epub 2013 Nov 9.
In emergency medicine intraosseous access (IOA) has been established as an alternative to conventional intravenous access. Originally the use of IOA was strictly limited to children up to 6 years of age and to adults for cardiopulmonary resuscitation. These limitations have been relaxed and the indications for IOA have been expanded.
A retrospective nationwide analysis of rescue missions by all helicopter emergency medical services of the German Automobile Club (ADAC) Air Rescue Service as well as the German Air Rescue (DRF) over a 7-year period was carried out.
A total of 466,813 patients were treated during the study period and an IOA was established in 1,498 (0.32 %) patients. There was a significant increase in using an IOA from 0.1-0.5 % (p < 0.05) from 2005 to 2011. Furthermore, there was an increase in using an IOA in elderly patients and in patients with lower degrees of severity according to the National Advisory Committee for Aeronautics (NACA) scales (2005-2011): decreased use of IOA in patients up to 6 years of age from 92.4 % to 19.7 % (p < 0.05) and in patients with NACA grades VII/VI from 74.4 % to 46.6 % (p < 0.05) and temporarily limited increase of non-indicated IOA use in patients with NACA grade III between 2008 and 2010. Furthermore, there was an increase in the number of the different drug groups used for intraosseous infusion over the study period.
The current guidelines and recommendations for the use of IOA in the prehospital setting are reflected more and more in mission reality for helicopter emergency medical services.
在急诊医学中，骨内通路（IOA）已被确立为传统静脉通路的替代方法。最初，IOA的使用严格限于6岁以下儿童以及用于心肺复苏的成人。这些限制已有所放宽，IOA的适应证也已扩大。
对德国汽车俱乐部（ADAC）空中救援服务以及德国空中救援（DRF）的所有直升机紧急医疗服务在7年期间的救援任务进行了全国性回顾性分析。
在研究期间共治疗了466,813例患者，其中1498例（0.32%）患者建立了IOA。从2005年到2011年，使用IOA的比例从0.1 - 0.5%显著增加（p < 0.05）。此外，根据美国国家航空咨询委员会（NACA）量表，老年患者和病情较轻患者使用IOA的情况有所增加（2005 - 2011年）：6岁以下患者使用IOA的比例从92.4%降至19.7%（p < 0.05），NACA VII/VI级患者从74.4%降至46.6%（p < 0.05），2008年至2010年期间NACA III级患者非适应证IOA使用暂时有限增加。此外，在研究期间用于骨内输注的不同药物组数量有所增加。
目前院前环境中使用IOA的指南和建议越来越多地反映在直升机紧急医疗服务的任务实际情况中。
