737 results match your criteria Intraosseous Access

Emergency department management of severely injured children in New South Wales.

Emerg Med Australas 2021 Jun 8. Epub 2021 Jun 8.

Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.

Objective: Presentations to EDs for major paediatric injury are considerably lower than for adults. International studies report lower levels of critical intervention, including intubation, required in injured children. A New South Wales study demonstrated an adverse event rate of 7. Read More

View Article and Full-Text PDF

Intraosseous Regional Administration of Antibiotic Prophylaxis in Total Knee Arthroplasty.

JBJS Essent Surg Tech 2020 Oct-Dec;10(4). Epub 2020 Dec 24.

Department of Orthopaedic Surgery, University of Auckland, Auckland, New Zealand.

Background: Periprosthetic joint infection (PJI) is a devastating complication following total knee arthroplasty (TKA), and perioperative antibiotics are commonly administered to try to mitigate the chance of infection. Intraosseous regional administration (IORA) of prophylactic antibiotics during TKA is a method of antibiotic delivery that has been shown to achieve markedly higher tissue concentrations at much lower doses. Other advantages include ease of administration, ability to time the antibiotic delivery with the surgical start time for maximal effectiveness, and less systemic side effects. Read More

View Article and Full-Text PDF
December 2020

Complications of Intraosseous Access: Two Case Reports From a Single Center.

JBJS Case Connect 2021 04 20;11(2). Epub 2021 Apr 20.

Department of Orthopaedics & Rehabilitation, Oregon Health and Science University, Portland, Oregon.

Cases: Intraosseous (IO) access is an effective surrogate for intravascular access in critically ill patients. We present 2 cases of IO complications. The first patient is a 44-year-old man with deep peroneal nerve sensorimotor dysfunction due to possible missed acute compartment syndrome from improper placement of a tibial IO needle. Read More

View Article and Full-Text PDF

Finding alternative sites for intraosseous infusions in newborns.

Resuscitation 2021 Apr 20;163:57-63. Epub 2021 Apr 20.

Department of Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str.62, 50937 Cologne, Germany.

Aim: Intraosseous (IO)-access plays an alternative route during resuscitation. Our study in preterm and term stillborns was performed to find alternative IO puncture sites beside the recommended proximal tibia.

Methods: The cadavers used were legal donations. Read More

View Article and Full-Text PDF

Validation of intraosseous delivery of valproic acid in a swine model of polytrauma.

Trauma Surg Acute Care Open 2021 17;6(1):e000683. Epub 2021 Mar 17.

Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.

Background: Intraosseous (IO) drug delivery may be necessary in emergency situations when intravenous access is unattainable. Valproic acid (VPA) is a histone deacetylase inhibitor that has previously been shown to improve survival in preclinical models of lethal polytrauma. In this study, we sought to compare serum levels of intravenously and IO-delivered VPA, and to analyze the effect of IO-delivered VPA. Read More

View Article and Full-Text PDF

Comparison of intraosseous access and central venous catheterization in Chinese adult emergency patients: A prospective, multicenter, and randomized study.

World J Emerg Med 2021 ;12(2):105-110

Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital; NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides; Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education; Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing 100191, China.

Background: It is challenging to establish peripheral intravenous access in adult critically patients. This study aims to compare the success rate of the first attempt, procedure time, operator satisfaction with the used devices, pain score, and complications between intraosseous (IO) access and central venous catheterization (CVC) in critically ill Chinese patients.

Methods: In this prospective clustered randomized controlled trial, eight hospitals were randomly divided into either the IO group or the CVC group. Read More

View Article and Full-Text PDF
January 2021

Safety of early norepinephrine infusion through peripheral vascular access during transport of critically ill children.

J Am Coll Emerg Physicians Open 2021 Apr 2;2(2):e12395. Epub 2021 Mar 2.

Pediatric Intensive Care Unit DMU 3 Santé de l'enfant et de l'adolescent AP-HP Paris Saclay University - Bicetre hospital Le Kremlin-Bicêtre France.

Study Objective: In prehospital and emergency settings, vasoactive medications may need to be started through a peripheral intravenous catheter. Fear of extravasation and skin injury, with norepinephrine specifically, may prevent or delay peripheral vasopressor initiation, though studies from adults suggest the actual risk is low. We sought to study the risk of extravasation and skin injury with peripheral administration of norepinephrine in children in the prehospital setting. Read More

View Article and Full-Text PDF

Intraosseous versus intravenous vascular access during cardiopulmonary resuscitation for out-of-hospital cardiac arrest: a systematic review and meta-analysis of observational studies.

Scand J Trauma Resusc Emerg Med 2021 Mar 8;29(1):44. Epub 2021 Mar 8.

Department of Emergency Medicine, National Taiwan University Hospital, No.7, Zhongshan S. Rd., Zhongzheng Dist., Taipei City, 100, Taiwan (Republic of China).

Introduction: This study is aimed to investigate the association of intraosseous (IO) versus intravenous (IV) route during cardiopulmonary resuscitation (CPR) with outcomes after out-of-hospital cardiac arrest (OHCA).

Methods: We systematically searched PubMed, Embase, Cochrane Library and Web of Science from the database inception through April 2020. Our search strings included designed keywords for two concepts, i. Read More

View Article and Full-Text PDF

Royale With Adrenalin: Intraosseous Versus IV Vascular Access for Out-of-Hospital Cardiac Arrest Resuscitation Epinephrine.

Pediatr Crit Care Med 2021 03;22(3):332-334

All authors: Department of Pediatrics, Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH.

View Article and Full-Text PDF

Intraosseous vascular access using the EZ-IO can be safely maintained in the adult proximal humerus and proximal tibia for up to 48 h: Report of a clinical study.

J Vasc Access 2021 Feb 5:1129729821992667. Epub 2021 Feb 5.

Department of Clinical Operations, ICON Early Phase Services, San Antonio, TX, USA.

Background: Historically, intraosseous (IO) vascular access devices cleared to market by the US FDA have been restricted to 24-h use. An observational study was conducted to determine the safety of IO access for a period up to 48 h in adult volunteers.

Methods: A 2-arm randomized, stratified, parallel assignment, prospective interventional study was conducted at ICON Early Phase Services in San Antonio, Texas, United States. Read More

View Article and Full-Text PDF
February 2021

Inexperienced but Confident: A Survey of Advanced Life Support Providers and Life-saving Interventions in the Israel Defense Forces.

Mil Med 2021 01;186(Suppl 1):261-265

Israel Defense Forces Medical Corps, Surgeon General's Headquarters, Military POB 02149 Tel Hashomer, Ramat Gan, Military Postal Code, Israel.

Objective: The objective of this study was to assess the current experience of Israel Defense Forces' (IDF) advanced life support (ALS) providers in performing life-saving interventions (LSIs), the rate of doctors and paramedics achieving the Trauma and Combat Medicine Branch benchmarks, and the rate of providers feeling confident in performing the interventions although not achieving the benchmarks.

Methods: This study was based on an online survey delivered to IDF ALS providers. The survey investigated demographics; experience in performing endotracheal intubation, cricothyroidotomy, tube thoracostomy, and intraosseous access on human patients; and confidence in performing these LSIs. Read More

View Article and Full-Text PDF
January 2021

Development and Evaluation of a 3D-Printed Adult Proximal Tibia Model for Simulation Training in Intraosseous Access.

Cureus 2020 Dec 20;12(12):e12180. Epub 2020 Dec 20.

Emergency Medicine, Carbonear General Hospital, Carbonear, CAN.

Intraosseous infusion remains an underutilized technique for obtaining vascular access in adults, despite its potentially life-saving benefits in trauma patients and those presenting to the emergency department. There is a scarcity of cost-effective, anatomically correct trainers to improve physician confidence and competency in this skill. The purpose of this report is to describe the development and evaluation of a three-dimensional (3D) printed Adult Proximal Intraosseous (IO) Tibia task trainer for simulation-based medical education. Read More

View Article and Full-Text PDF
December 2020

Successful Intraosseous Thrombolysis in the Management of a Massive Pulmonary Embolism With Cardiac Arrest.

Cureus 2020 Dec 16;12(12):e12105. Epub 2020 Dec 16.

Intensive Care Unit, Newham University Hospital / Barts NHS Health Trust, London, GBR.

We describe the successful cardiopulmonary resuscitation of a patient with massive pulmonary embolism who received thrombolysis via the intraosseous route. This case also demonstrates survival without apparent long-term sequelae despite extreme metabolic acidosis. In the context of pulmonary embolism, this has not been widely reported in the existing literature. Read More

View Article and Full-Text PDF
December 2020

Intraosseus Route For Thrombolysing Acute Stroke Is Safe And Successful.

QJM 2021 Jan 24. Epub 2021 Jan 24.

Norfolk and Norwich Hospital NHS Foundation Trust, UK.

Use of intraosseous route in thrombolysis of acute stroke patients remains a rare entity. Here, we describe the first such case within UK of a 55-year-old female patient of acute stroke who was thrombolysed with Alteplase administered through intraosseous (IO) route. She initially presented to A&E with severe dysarthria dysphasia and left sided weakness with an NIHSS-8. Read More

View Article and Full-Text PDF
January 2021

Intraosseous contrast administration for emergency stroke CT.

Neuroradiology 2021 Jun 18;63(6):967-970. Epub 2021 Jan 18.

Clinic for Radiology, University Hospital Muenster, Muenster, Germany.

Computed tomography (CT) imaging in acute stroke is an established and fairly widespread approach, but there is no data on applicability of intraosseous (IO) contrast administration in the case of failed intravenous (IV) cannula placement. Here, we present the first case of IO contrast administration for CT imaging in suspected acute stroke providing a dedicated CT examination protocol and analysis of achieved image quality as well as a review of available literature. Read More

View Article and Full-Text PDF

[When emergency physician and tele-emergency physician save life together : A case description on the application of prehospital telemedicine for ventricular tachycardia with hemodynamic instability].

Anaesthesist 2021 01 15;70(1):34-39. Epub 2021 Jan 15.

Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.

Telemedicine has already entered the rescue service in some regions of Germany. This case description is about a telemedical emergency physician case where an emergency doctor was also at the scene of the emergency. The patient had a life-threatening ventricular tachycardia and became hemodynamically unstable. Read More

View Article and Full-Text PDF
January 2021

Intraosseous or Peripheral IV Access in Pediatric Cardiac Arrest? Results From the French National Cardiac Arrest Registry.

Pediatr Crit Care Med 2021 03;22(3):286-296

Department of Pediatric Critical Care, University of Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France.

Objectives: Despite the evolving recommendations that favor the use of intraosseous access in pediatric resuscitation, the impact of vascular access type on survival in young children has not been demonstrated. The aim of this study was to assess the impact of the intravascular injection route on the return on spontaneous circulation, survival to hospital admission (0 day), and 30 days or survival to hospital discharge, by comparing survival rates in young children having intraosseous and peripheral IV access. The second aim was to compare the rates of favorable neurologic outcome after 30 days or survival to hospital discharge. Read More

View Article and Full-Text PDF

Life-Saving Procedures Performed While Wearing CBRNe Personal Protective Equipment: A Mannequin Randomized Trial.

Simul Healthc 2021 Jan 8;Publish Ahead of Print. Epub 2021 Jan 8.

From the Department of Medicine (DIMED) (G.M., M.P., C.A., S.S., F.F.), University of Padova, Padova; Venice Emergency Medical Service Operations Center (N.B., D.P.), Venezia; and Istituto di Anestesia e Rianimazione-Azienda Ospedaliera Universitaria di Padova (A.G., P.N.), Padova, Italy.

Introduction: Chemical-biological-radiological-nuclear-explosive (CBRNe) are complex events. Decontamination is mandatory to avoid harm and contain hazardous materials, but can delay care. Therefore, the stabilization of patients in the warm zone seems reasonable, but research is limited. Read More

View Article and Full-Text PDF
January 2021

Intraosseous versus intravenous access while wearing personal protective equipment: a meta-analysis in the era of COVID-19.

Kardiol Pol 2021 03 7;79(3):277-286. Epub 2021 Jan 7.

Background: Obtaining vascular access is one of the key procedures performed in patients in emergency settings.

Aims: The study was conducted as a meta‑analysis and a systematic review and aimed to address the following question: which intravascular access method should be used in patients with COVID‑19 when wearing full personal protective equipment (PPE)?

Methods: We performed a systematic search of PubMed, EMBASE, and CENTRAL databases for randomized controlled trials that compared intravascular access methods used by operators wearing full level C PPE. We evaluated procedure duration and the success rate of intraosseous and peripheral intravenous accesses. Read More

View Article and Full-Text PDF

Central line catheterisation as a cause of vocal cord palsy.

J Surg Case Rep 2020 Dec 28;2020(12):rjaa539. Epub 2020 Dec 28.

Ear, Nose and Throat Department, Queen Elizabeth Hosplital Birmingham, Birmingham B15 2TH, United Kingdom.

We report an unusual case of vocal cord palsy secondary which developed following insertion of a central line. A 46-year-old gentleman was admitted with seizure activity and reduced GCS. Following failed attempts at establishing intravenous or intraosseous access, a central line was placed into the right internal jugular vein. Read More

View Article and Full-Text PDF
December 2020

Intravenous vs intraosseous adrenaline administration in cardiac arrest: A protocol for systematic review and meta-analysis.

Medicine (Baltimore) 2020 Dec;99(52):e23917

Department of General Practice and National Clinical Research Center for Geriatrics, International Medical Center, West China Hospital, Sichuan University, Chengdu, China.

Introduction: Cardiac arrest refers to the sudden termination of cardiac ejection function due to various causes. Adrenaline is an important component of resuscitation among individuals experiencing cardiac arrest. The adrenaline delivery method chiefly involved intraosseous infusion and intravenous access. Read More

View Article and Full-Text PDF
December 2020

Point-of-Care Ultrasound for the Evaluation and Management of Febrile Infants.

Pediatr Emerg Care 2020 Dec 2. Epub 2020 Dec 2.

Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York Presbyterian-Morgan Stanley Children's Hospital, New York, NY.

Background: Febrile infants frequently present to the emergency department (ED) and account for a vulnerable population at significant risk for serious bacterial infection. Appropriate evaluation and management are key to favorable outcomes but can present challenges for providers, especially in EDs where ill children are infrequently seen and pediatric-trained staff may not be available. Point-of-care ultrasound (POCUS) is integrated into the care of adults in the ED but is less commonly used for infants. Read More

View Article and Full-Text PDF
December 2020

Clinical evaluation of intravenous alone versus intravenous or intraosseous access for treatment of out-of-hospital cardiac arrest.

Resuscitation 2021 02 19;159:129-136. Epub 2020 Nov 19.

Department of Emergency Medicine, Singapore General Hospital, Outram Road, 169608, Singapore; Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, 169857, Singapore. Electronic address:

Objective: Obtaining vascular access during out-of-hospital cardiac arrest (OHCA) is challenging. The aim of this study was to determine if using intraosseous (IO) access when intravenous (IV) access fails improves outcomes.

Methods: This was a prospective, parallel-group, cluster-randomised study that compared 'IV only' against 'IV + IO' in OHCA patients, where if 2 IV attempts failed or took more than 90 s, paramedics had 2 further attempts of IO. Read More

View Article and Full-Text PDF
February 2021

Use of Intraosseous Vascular Access During Neonatal Resuscitation at a Tertiary Center.

Front Pediatr 2020 18;8:571285. Epub 2020 Sep 18.

Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.

Emergency vascular access is rarely required during neonatal resuscitation. We aimed to analyze frequency of use, success, and complication rates of intraosseous (IO) vascular access in neonates at a single tertiary neonatal intensive care unit. We performed a questionnaire-based survey among pediatric residents, pediatricians, and neonatologists, asking for the use of IO access in neonates between April 1st, 2015, and April 30th, 2020. Read More

View Article and Full-Text PDF
September 2020

Percutaneous image-guided double oblique anterior approach to the acetabulum for cementoplasty.

Clin Radiol 2020 12 29;75(12):964.e7-964.e12. Epub 2020 Sep 29.

Department of Interventional Radiology, Nouvel Hôpital Civil, 1, Place de L'Hôpital, 67096 Cedex, Strasbourg, France.

Aim: To report the technique of percutaneous double oblique anterior access to the acetabulum and evaluate its feasibility and safety.

Materials And Methods: Pelvic computed tomography (CT) examinations of 60 patients (30 men and 30 women; mean age 62.6±13. Read More

View Article and Full-Text PDF
December 2020

Massive Gastrointestinal Hemorrhage.

Emerg Med Clin North Am 2020 Nov 30;38(4):871-889. Epub 2020 Jul 30.

St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07503, USA.

Massive gastrointestinal hemorrhage is a life-threatening condition that can result from numerous causes and requires skilled resuscitation to decrease patient morbidity and mortality. Successful resuscitation begins with placement of large-bore intravenous or intraosseous access; early blood product administration; and early consultation with a gastroenterologist, interventional radiologist, and/or surgeon. Activate a massive transfusion protocol when initial red blood cell transfusion does not restore effective perfusion or the patient's shock index is greater than 1. Read More

View Article and Full-Text PDF
November 2020

Informed self-assessment versus preceptor evaluation: a comparative study of pediatric procedural skills acquisition of fifth year medical students.

BMC Med Educ 2020 Sep 21;20(1):318. Epub 2020 Sep 21.

Department of Pediatrics, Faculty of Medicine, University of Tripoli, Tripoli, Libya.

Background: Simulation training is widely used in medical education as students rarely perform clinical procedures, and confidence can influence practitioners' ability to perform procedures. Thus, this study assessed students' perceptions and experiences of a pediatric skills program and compared their informed self-assessment with their preceptor-evaluated performance competency for several pediatric clinical procedures.

Methods: A total of 65 final-year medical students attended a weeklong pediatric skills training course by the University of Tripoli that used a manikin and various clinical scenarios to simulate real-life cases. Read More

View Article and Full-Text PDF
September 2020

Intraosseous Plate Reduction and Fixation of Complex Proximal Ulnar Fractures: A Report of 2 Cases.

JBJS Case Connect 2020 Jul-Sep;10(3):e1900396

1Department of Orthopedic Surgery, Prisma Health-Upstate, Greenville, South Carolina.

Case: We describe 2 cases using a novel technique of intraosseous plating of the coronoid as a reduction tool and fixation construct for complex elbow fracture dislocations. Each patient sustained traumatic, complex injuries of the elbow and were radiographically healed at the final follow-up.

Conclusion: Elbow fracture dislocations are complex injuries because of the interplay between primary and secondary stabilizers. Read More

View Article and Full-Text PDF

Point-of-Care Ultrasound to Identify Landmarks of the Proximal Humerus: Potential Use for Intraosseous Vascular Access.

J Ultrasound Med 2021 Apr 3;40(4):725-730. Epub 2020 Sep 3.

Division of Cardiothoracic Anesthesia, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA.

Objectives: The inability to identify landmarks is an absolute contraindication for intraosseous access. The feasibility of landmark identification using ultrasound (US) has been demonstrated on human cadavers. We aimed to study the feasibility of point-of-care US in identifying proximal humerus landmarks in living human patients. Read More

View Article and Full-Text PDF

Successful intraosseous factor VIII application in a haemophilic emergency.

J Clin Pharm Ther 2021 Feb 29;46(1):212-214. Epub 2020 Aug 29.

Department of Paediatric Haematology and Oncology, University Hospital "Tzaritza Giovanna - ISUL", Sofia, Bulgaria.

What Is Known And Objectives: Intravenous (IV) replacement therapy with plasma derived or recombinant factor VIII (FVIII) and factor IX concentrates is the mainstay for treatment of patients with haemophilia A and B. Therefore, the current therapy is particularly dependent on the presence of a secure IV access especially in case of emergency.

Case Description: A life-threatening bleeding event in an 8-month-old boy is managed by intraosseous (IO) infusion of recombinant FVIII concentrate. Read More

View Article and Full-Text PDF
February 2021