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Factors associated with failure of intraosseous access in prehospital trauma treatment by military medical personnel
  1. Mor Rittblat1,2,3,4,
  2. D Kotovich1,4,
  3. N Tsur1,4,
  4. Z Beer1,3,
  5. I Radomislensky1,5,
  6. S Gendler1,
  7. O Almog1,3,
  8. A M Tsur1,6,
  9. G Avital1,7 and
  10. T Talmy1,3,7
  1. 1Israeli Defense Forces Medical Corps, Tel Hashomer, Ramat Gan, Israel
  2. 2Department of Preventive Medicine and Epidemiology, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
  3. 3Department of Military Medicine and 'Tzameret', Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
  4. 4Department of Plastic and Reconstructive Surgery, Hadassah Hebrew University Medical Centre, Jerusalem, Israel
  5. 5The Israel National Center for Trauma & Emergency Medicine Research, Gertner Institute of Epidemiology and Health Policy Research, Tel Hashomer, Ramat Gan, Israel
  6. 6Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Tel Aviv University, Petach Tiqva, Israel
  7. 7Division of Anesthesia, Intensive Care & Pain Management, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
  1. Correspondence to Dr Mor Rittblat; rittblat{at}gmail.com

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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Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.

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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.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.