Deathmatch : Central Access Versus Intraosseous Access. FIGHT!

In the January edition of Resuscitation, is a prospective observational study, investigating the success rates on first attempt and procedure times of IO access, aginst central venous access in adults with difficult peripheral veins in the context of acute resuscitation - either traumatic or medical, in a level 1 trauma centre.

And what did they find, I hear you ask?? Well, it comes as little surprise that IO vascular access was found to be rapid, and reliable in the context of acute resuscitation, with a higher success rate on first attempt, and a lower procedure time when compared to  land mark based CVC. 

INTRODUCTION:

Current European Resuscitation Council (ERC) guidelines recommend intraosseous (IO)vascular access, if intravenous (IV) access is not readily available. Because central venous catheterisation (CVC) is an established alternative for in-hospital resuscitation, we compared IO access versus landmark-based CVC in adults with difficult peripheral veins.

METHODS:

In this prospective observational study we investigated success rates on first attempt and procedure times of IO access versus central venous catheterisation (CVC) in adults (≥18 years of age) withinaccessible peripheral veins under trauma or medical resuscitation in a level I trauma centre emergencydepartment.

RESULTS:

Forty consecutive adults under resuscitation were analysed, each receiving IO access and CVC simultaneously. Success rates on first attempt were significantly higher for IO cannulation than CVC (85%versus 60%, p=0.024) and procedure times were significantly lower for IO access compared to CVC (2.0versus 8.0min, p<0.001). As for complications, failure of IO access was observed in 6 patients, while 2 or more attempts of CVC were necessary in 16 patients. No other relevant complications like infection, bleeding or pneumothorax were observed.

CONCLUSIONS:

IO vascular access is a reliable bridging method to gain vascular access for in-hospital adult patients under resuscitation with difficult peripheral veins. Moreover, IO access is more efficacious with a higher success rate on first attempt and a lower procedure time compared to landmark-based CVC.

There is an increasing body of evidence, supporting the role of intraosseous access in the acute resuscitation situation, where tradiotional IV access is problematic (e.g the severe burns patient). What are you currently doing in your department?

Resuscitation. 2012 Jan;83(1):40-5. Epub 2011 Sep 3.