Article Text
Abstract
Introduction Intraosseous devices have become an alternative to peripheral intravenous (PIV) access. Despite the established success of intraosseous devices in laboratory and simulator studies, there is a lack of data regarding their real-world utilisation in prehospital settings. Therefore, this study aims to evaluate the success rates of intraosseous access in a prehospital military context and identify factors associated with failure.
Methods Using the Israel Defense Forces (IDF) Trauma Registry, we retrospectively collected data from 2010 to 2023. The primary outcome was the first pass success rate of intraosseous access, and logistic regression models were applied to identify variables associated with first pass failure.
Results The study included 172 trauma patients who underwent attempted intraosseous access with 46.5% cases which were classified as military events. The median age was 22 years, and 17.3% were paediatric patients. First pass success was achieved in 67.4% of cases, with a cumulative success rate of 80.8% after multiple attempts. Moreover, significant differences were noted when examining the success rate of the three intraosseous devices used by the IDF teams, with the highest success rate being documented for the NIO Adult versus the EZ-IO or the BIG (81.4%; 76.7%; 62.4%). However, logistic regression analysis revealed that the number of PIV access attempts was the only variable significantly associated with decreased odds of achieving first pass intraosseous access.
Conclusion These findings suggest that intraosseous devices are a viable alternative for establishing vascular access in prehospital military settings. However, success rates were slightly lower than previous reports, potentially due to the severity of injuries in the study cohort. Our analyses revealed a higher number of PIV access attempts correlated with reduced first pass intraosseous success, possibly stemming from caregiver proficiency in obtaining vascular access. Further research is needed to explore additional factors affecting intraosseous access success rates.
- ACCIDENT & EMERGENCY MEDICINE
- EDUCATION & TRAINING (see Medical Education & Training)
- INTENSIVE & CRITICAL CARE
- Trauma management
Data availability statement
Data sharing not applicable as no datasets generated and/or analysed for this study.
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- ACCIDENT & EMERGENCY MEDICINE
- EDUCATION & TRAINING (see Medical Education & Training)
- INTENSIVE & CRITICAL CARE
- Trauma management
Data availability statement
Data sharing not applicable as no datasets generated and/or analysed for this study.
Footnotes
X @talmymd
Presented at This work was presented at the Biennial Conference of the Israel Surgeons Association, Kfar Blum, Israel, May 2023.
Contributors MR: guarantor, data curation, investigation, methodology, project administration, writing—original draft and editing. DK and NT: data curation, investigation, project administration, writing—original draft and editing. ZB: investigation, methodology, writing—review and editing. IR: conceptualisation, data curation, investigation, formal analysis, methodology, writing—review. SG: data curation, investigation. OA: data curation, investigation, methodology, writing—review and editing, supervision. AMT: visualisation, data curation, investigation, formal analysis, methodology, editing. GA: conceptualisation, methodology, supervision, editing. TT: data curation, investigation, methodology, conceptualisation, supervision, writing—review and editing.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.
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