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Letter to the Editor

Use IV, Not IO, Access in Cardiac Arrest

Emergency Medicine News: May 2019 - Volume 41 - Issue 5 - p 30
doi: 10.1097/01.EEM.0000558214.05574.3f
Letter to the Editor


Dr. Christine Butts' article, “Ultrasound Can Shorten Pulse Checks during CPR,” discusses promising ultrasound interventions outside of the standard ACLS protocols. (EMN. 2019; 41[3]:1; As interesting as these interventions are, we need to focus on ensuring that all cardiac arrest patients are resuscitated with IV access, never IO.

The 2015 AHA guidelines, referring to IO administration of resuscitative medications, state, “There is little information on the efficacy and effectiveness of such administration in clinical cardiac arrest during ongoing CPR.” They further state that IO v. IV access is considered Class IIa LOE C v. Class Ia LOE A, respectively. As of 2019, no animal or human research supports using IO access over IV, especially in an era of POCUS. On the other hand, animal and human studies say just the opposite. (Mil Med. 2014;179[1]:99; Ann Emerg Med. 2018;71[5]:588).

These interesting ultrasound interventions outside the scope of ACLS guidelines should not make us lose sight of the fact that POCUS can achieve nearly 100 percent IV access during ACLS, the impact of which will be studied.

Mel Harris, MD

Loma Linda, CA

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