Intraosseous Access Publications (537)


Intraosseous Access Publications

Am J Disaster Med
Am J Disaster Med 2016 Spring;11(2):119-123
Medical Director, Office of the Medical Director, University of Texas Health Science Center at San Antonio, San Antonio, Texas.

The 2015 advanced cardiac life support update continues to advocate administering epinephrine during cardiac arrest. The goal of our study is to determine if prehospital intraosseous (IO) access results in shorter time to epinephrine than prehospital peripheral intravenous (PIV) access.
The out-of-hospital cardiac arrest (OHCA) database of a large, urban, fire-based emergency medical services system was searched for consecutive cases of OHCA between January 2013 and December 2015. Read More

The time to the first dose of epinephrine was calculated and compared by vascular access technique utilized (PIV or IO). Descriptive statistics were used to report first pass success and IO complications.
A total of 3,470 OHCA cases were treated during the study period. Of those cases, 2,656 met our inclusion criteria. There were 2,601 cases of IO usage and 55 cases of PIV usage. The mean time from arrival at the patient's side to administration of the first dose of epinephrine was 5.0 minutes (95% CI: 4.7 minutes, 5.4 minutes) for the IO group and 8.8 minutes (95% CI: 6.6 minutes, 10.9 minutes) for the PIV group (p<0.001). There were a total of 2,879 IO attempts with 2,753 IOs successfully placed in 2,601 patients. The first pass IO success rate was 95.6 percent (2,753/2,879).
In the setting of OHCA, the time to administer the first dose of epinephrine was faster in the IO access group when compared to PIV access group. The prehospital use of IO vascular access for time-dependent medical conditions is recommended.

Pediatr Emerg Care
Pediatr Emerg Care 2017 Jan;33(1):47-48
From the Departments of Paediatrics and Medicine, Schulich School of Medicine at Western University, Children's Hospital at London Health Sciences Centre, London, Ontario, Canada.

Supraventricular tachycardia is a common arrhythmia faced by emergency physicians in the pediatric population. In most cases, antecubital intravenous access can be established, and adenosine can be administered in a rapid and timely fashion. The role and administration of intraosseous adenosine are poorly established. Read More

We describe a case where the administration of adenosine was successful via a mixed method administration.

Case Rep Crit Care
Case Rep Crit Care 2016 27;2016:4382481. Epub 2016 Nov 27.
Department of Pulmonary and Critical Care, CHI Creighton University Medical Center, Omaha, NE, USA.
Am J Emerg Med
Am J Emerg Med 2016 Dec 12. Epub 2016 Dec 12.
Emergency Medicine, UCSF Fresno, United States. Electronic address:

In the early phases of resuscitation in a critically ill patient, especially those in cardiac arrest, intravenous (IV) access can be difficult to obtain. Intraosseous (IO) access is often used in these critical situations to allow medication administration. When no IV access is available, it is difficult to obtain blood for point of care analysis, yet this information can be crucial in directing the resuscitation. Read More

We hypothesized that IO samples may be used with a point of care device to obtain useful information when seconds really do matter.
Patients presenting to the emergency department requiring resuscitation and IO placement were prospectively enrolled in a convenience sample. 17 patients were enrolled. IO and IV samples obtained within five minutes of one another were analyzed using separate EPOC® point of care analyzers. Analytes were compared using Bland Altman Plots and intraclass correlation coefficients.
In this analysis of convenience sampled critically ill patients, the EPOC® point of care analyzer provided results from IO samples. IO and IV samples were most comparable for pH, bicarbonate, sodium and base excess, and potentially for lactic acid; single outliers for bicarbonate, sodium and base excess were observed. Intraclass correlation coefficients were excellent for sodium and reasonable for pH, pO2, bicarbonate, and glucose. Correlations for other variables measured by the EPOC® analyzer were not as robust.
IO samples can be used with a bedside point of care analyzer to rapidly obtain certain laboratory information during resuscitations when IV access is difficult.

Crit. Care Med.
Crit Care Med 2017 Jan;45(1):e117
Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland; Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland.
Top Companion Anim Med
Top Companion Anim Med 2016 Jun 30;31(2):61-67. Epub 2016 Aug 30.
Purdue University Intensive Care Unit and Emergency Service Supervisor, West Lafayette, IN, USA. Electronic address:

Fluid resuscitation in small animals is important in emergency situations and is utilized by every veterinary practice. Peripherally inserted intravenous catheters are an effective way of giving fluids to a veterinary patient. If an intravenous catheter is not obtainable, there are multiple other ways to administer fluids to a patient including dorsal pedal catheters, intraosseous catheters, central venous catheters, peripherally inserted central catheters, nasogastric tubes, nasoesophageal tubes and subcutaneous administration of fluids. Read More

This article will discuss the advantages and disadvantages of each way of administration.


The available routes of administration commonly used for medications and fluids in the acute care setting are generally limited to oral, intravenous, or intraosseous routes, but in many patients, particularly in the emergency or critical care settings, these routes are often unavailable or time-consuming to access. A novel device is now available that offers an easy route for administration of medications or fluids via rectal mucosal absorption (also referred to as proctoclysis in the case of fluid administration and subsequent absorption). Although originally intended for the palliative care market, the utility of this device in the emergency setting has recently been described. Read More

Specifically, reports of patients being treated for dehydration, alcohol withdrawal, vomiting, fever, myocardial infarction, hyperthyroidism, and cardiac arrest have shown success with administration of a wide variety of medications or fluids (including water, aspirin, lorazepam, ondansetron, acetaminophen, methimazole, and buspirone). Device placement is straightforward, and based on the observation of expected effects from the medication administrations, absorption is rapid. The rapidity of absorption kinetics are further demonstrated in a recent report of the measurement of phenobarbital pharmacokinetics. We describe here the placement and use of this device, and demonstrate methods of pharmacokinetic measurements of medications administered by this method.

During resuscitation in the field, intraosseous (IO) access may be achieved using a variety of available devices, often attempted by inexperienced users.
We sought to examine the success rate and ease-of-use ratings of an IO device, the NIO® (New Intraosseous Persys Medical, Houston, TX, USA) in comparison to the Arrow® EZ-IO® (Teleflex Medical Research Triangle Park, NC, USA) by novice users.
We performed a randomized crossover trial. Read More

The study model was a porcine hind leg which was cut distally in order to expose the marrow. The Study population was composed of pre-graduate medical students without prior experience in IO use, all designated future field physicians. The students underwent instruction and practiced the use of both devices. After practice completion, each student attempted a single IO insertion with both devices sequentially in randomized fashion. Success was defined as a flow of fluid through the bone marrow after a single IO attempt. Investigators which determined the success rate were blinded to the used device.
50 users (33 males, 17 females) participated in the trial, mean age of 21.7 years (±1). NIO users were successful in 92% (46/50) attempts while EZ-IO user success rate was 88% (44/50). NIO success rates were comparable to those of EZ-IO (p = NS). Results were similar when examining only the initial device used. Median score of ease of use was 4 (5 point Likert scale) in both devices (p = NS). 54% (27/50) of the participants preferred using the EZ-IO over the NIO (p = NS).
Novice users were equally successful in establishing IO access with the NIO® in comparison to the EZ-IO® in a porcine model.

Am J Emerg Med
Am J Emerg Med 2016 Nov 2. Epub 2016 Nov 2.
Copenhagen Academy for Medical Education and Simulation, Capital Region of Denmark, Denmark. Electronic address: