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Intraosseous Versus Central Venous Catheter Utilization and Performance During Inpatient Medical Emergencies

Lee, Peter M. J. MD, MHS1; Lee, Christina MD2; Rattner, Peter MD2; Wu, Xiaoping MD2; Gershengorn, Hayley MD3; Acquah, Samuel MD1

doi: 10.1097/CCM.0000000000000942
Clinical Investigations
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Objectives: Intraosseous access is a rapid and effective route of fluid and drug administration. Its use has been proven in emergency medicine, pediatrics, and the military. We aimed to assess its performance and utilization against landmark-guided central venous catheter placement during inpatient medical emergencies.

Design: Prospective observational study.

Setting: Eight hundred fifty-six–bed urban teaching hospital.

Patients: Adult inpatients requiring central venous access during medical emergencies.

Interventions: Intraosseous device training was added to standard central venous catheter training beginning in February 2012. Intraosseous were used as primary access in cardiac arrests and secondary access if central venous catheter placement failed during noncardiac arrest emergencies. An online survey was conducted among intraosseous and central venous catheter operators to assess their experience and any barriers to use.

Measurements and Main Results: Seventy-nine adults had central access placement from February 2012 to July 2013. Sixty were during medical emergency team calls, and 19 were cardiac arrests. Thirty-one received intraosseous device, and 48 received a central venous catheter. First-pass success was significantly higher for intraosseous than for central venous catheter (90.3 vs 37.5%; 95% CI, 80–101 vs 24–51; p < 0.001). Mean placement times were significantly shorter for intraosseous than for central venous catheter (1.2 vs 10.7 min; p < 0.001). There were a total of 33 intraosseous versus 169 central venous catheter attempts with fewer attempts on average per patient during intraosseous placement (1.1 vs 2.8; p < 0.001). There were three intraosseous-related complications and 22 central venous catheter-related complications. Our survey showed high satisfaction with intraosseous training and operation. Among the barriers cited, timely intraosseous kit acquisition was most common.

Conclusions: It is feasible to incorporate intraosseous use during medical emergency team calls. Intraosseous had significantly higher first-pass success rates and faster placement compared with central venous catheters. Intraosseous operators reported high satisfaction and confidence in its use. Prospective randomized studies comparing intraosseous and central venous catheter are warranted.

Supplemental Digital Content is available in the text.

1Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Mount Sinai Beth Israel Medical Center, Icahn School of Medicine, New York, NY.

2Department of Medicine, Mount Sinai Beth Israel Medical Center, Icahn School of Medicine, New York, NY.

3Division of Critical Care Medicine, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Dr. Gershengorn and her institution received grant support (research grant to start July 1, 2014, for 1 year).The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: peterjosephlee@gmail.com

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