Research Forum abstract267: Humeral Intraosseous Access Success Rate In Adult Out–of–Hospital Cardiac Arrest
Section snippets
Study Objectives
Intraosseous access in the proximal humerus has been demonstrated to deliver high infusion rates with rapid drug delivery to central circulation for the critically ill or injured. Studies demonstrate clinicians can access the proximal humerus with a high degree of success in the classroom or laboratory setting, but literature review offers no studies on success in the out of hospital cardiac arrest patient.
Methods
A retrospective cohort analysis was conducted from a cardiac arrest database maintained by the Office of the Medical Director in a large urban EMS system. This data base, a component of a comprehensive quality assurance/quality improvement program, data is collected during post cardiac arrest debriefings for out-of-hospital patient management. Humeral intraosseous access was achieved by paramedics using the EZ-IO device (Vidacare Corporation, San Antonio TX, USA). Clinical staff received
Results
There were 405 cardiac arrests evaluated with an average age of 63 (+/-16) years and 58% male. Humeral access was attempted in 61% (n=247) of these patients; the balance had either tibial intraosseous, venous or central access. First attempt successful placement (defined as stable placement with sufficient flow) was 91% (n=224 [95%CI 86% to 94%]) with overall success rate of 94% (n=232 [95% CI 90% to 96%]) considering subsequent attempts (max 2 attempts). There were 15 (6%) unsuccessful
Conclusion
This study suggests a high degree of paramedic success in establishing intraosseous access in the out-of-hospital cardiac arrest patient. Few reported complications suggest humeral IO access is a reliable method of fluid and medication delivery in the out-of-hospital cardiac arrest population.