Guest guest Posted February 22, 2009 Report Share Posted February 22, 2009 Well another sounds good practice in EMS being found of no real benefit. It is sad that we have so many things done just because thats the way its always been done. It would be nice to see more studys done and have EMS start practicing fact based medicine rather than tradition. Thats for providing the information Dr Bledsoe. Renny Just my opinion for as little as its worth. > > Here is another interesting article (abstract) out of Lubbock published in > January 2009 Prehospital Emergency Care: > > > > Intraosseous Line Placement Does Not Improve Outcome in Adults with > Out-of-Hospital Cardiac Arrest C. Schutt, Bryson Bowman, Cihan Cevik, > Nadia Essa, Love Lee, n Macedo, Bruce Mowrey, Ratcliff, > L. Whitworth, Phy, Texas Tech University School of Medicine > > Objective. The purpose of this study was to determine if intraosseous (IO) > line placement improves outcome in adult patients with out-of- hospital > cardiac arrest. > > Methods. The study design was a retrospective cohort study. Inclusion > criteria were any patient 18 years or older with out-of-hospital cardiac > arrest transported to the emergency department (ED). The cohort was divided > based on the attempted placement of an IO line prior to ED arrival. IO > access was achieved using the EZ-IOR device. IO lines were placed in the > tibial tuberosity. Outcome measures were patient arrival at the ED with a > pulse and survival to hospital discharge. > > Results. 165 patients met the inclusion criteria for the study. IO placement > was attempted in 24 (14.5%) of 165 patients and was successful in 22 > patients (91.7%). Both failures were attributed to excess adipose tissue. In > patients who had IO access attempted, three (12.5%) of 24 arrived at the ED > with a pulse and zero (0%) survived to hospital discharge. In comparison, 39 > (27.7%) of 141 patients in which an IO line was not attempted arrived at the > ED with a pulse and seven (5.0%) survived to hospital discharge. The patient > groups did not differ significantly with regard to age, time of call to > ambulance arrival, body mass index, number of intravenous attempts, or time > on scene. After adjusting for the initial cardiac rhythm and if the arrest > was witnessed, univariate and multivariate regression analysis showed that > there was no significant difference between patient groups who had an IO > line placed and those who did not with regard to either arrival at the ED > with a pulse or survival to hospital discharge (p = 0.7, p = 0.6, > respectively). > > Conclusions. The results of this study suggest tibial IO placement is not > associated with improved survival in adult out-of-hospital cardiac arrest, > and adopting IO line placement as an alternative to direct venous access in > adult cardiac arrest cannot be recommended on the basis of improving patient > survival. > > > > This really doesn't surprise me as I we are finding no drug really effective > in cardiac arrest (and this is not a knock of the EZ-IO for I am sure the > results would be the same for the B.I.G. and similar technology). I have > felt that the role of the IO is limited (sepsis, cardiac arrest) and would > have thought that, if anything, there would have been an improvement in > cardiac arrest. I think the EZ-IO is a great device (made in Texas) but a > bit expensive. It will be interesting to watch the research roll in. For > me, the more intuitive a device or practice seems, the more likely it is to > be debunked by empiric study. Maybe Dr. Ken Mattox is on the right track (he > often is) when he says he sees no role whatsoever for these alternative IV > sites (central lines [prehospital], IOs, etc.). However, therapeutic > hypothermia seems promising and IC/IO access there is required. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 22, 2009 Report Share Posted February 22, 2009 Well another sounds good practice in EMS being found of no real benefit. It is sad that we have so many things done just because thats the way its always been done. It would be nice to see more studys done and have EMS start practicing fact based medicine rather than tradition. Thats for providing the information Dr Bledsoe. Renny Just my opinion for as little as its worth. > > Here is another interesting article (abstract) out of Lubbock published in > January 2009 Prehospital Emergency Care: > > > > Intraosseous Line Placement Does Not Improve Outcome in Adults with > Out-of-Hospital Cardiac Arrest C. Schutt, Bryson Bowman, Cihan Cevik, > Nadia Essa, Love Lee, n Macedo, Bruce Mowrey, Ratcliff, > L. Whitworth, Phy, Texas Tech University School of Medicine > > Objective. The purpose of this study was to determine if intraosseous (IO) > line placement improves outcome in adult patients with out-of- hospital > cardiac arrest. > > Methods. The study design was a retrospective cohort study. Inclusion > criteria were any patient 18 years or older with out-of-hospital cardiac > arrest transported to the emergency department (ED). The cohort was divided > based on the attempted placement of an IO line prior to ED arrival. IO > access was achieved using the EZ-IOR device. IO lines were placed in the > tibial tuberosity. Outcome measures were patient arrival at the ED with a > pulse and survival to hospital discharge. > > Results. 165 patients met the inclusion criteria for the study. IO placement > was attempted in 24 (14.5%) of 165 patients and was successful in 22 > patients (91.7%). Both failures were attributed to excess adipose tissue. In > patients who had IO access attempted, three (12.5%) of 24 arrived at the ED > with a pulse and zero (0%) survived to hospital discharge. In comparison, 39 > (27.7%) of 141 patients in which an IO line was not attempted arrived at the > ED with a pulse and seven (5.0%) survived to hospital discharge. The patient > groups did not differ significantly with regard to age, time of call to > ambulance arrival, body mass index, number of intravenous attempts, or time > on scene. After adjusting for the initial cardiac rhythm and if the arrest > was witnessed, univariate and multivariate regression analysis showed that > there was no significant difference between patient groups who had an IO > line placed and those who did not with regard to either arrival at the ED > with a pulse or survival to hospital discharge (p = 0.7, p = 0.6, > respectively). > > Conclusions. The results of this study suggest tibial IO placement is not > associated with improved survival in adult out-of-hospital cardiac arrest, > and adopting IO line placement as an alternative to direct venous access in > adult cardiac arrest cannot be recommended on the basis of improving patient > survival. > > > > This really doesn't surprise me as I we are finding no drug really effective > in cardiac arrest (and this is not a knock of the EZ-IO for I am sure the > results would be the same for the B.I.G. and similar technology). I have > felt that the role of the IO is limited (sepsis, cardiac arrest) and would > have thought that, if anything, there would have been an improvement in > cardiac arrest. I think the EZ-IO is a great device (made in Texas) but a > bit expensive. It will be interesting to watch the research roll in. For > me, the more intuitive a device or practice seems, the more likely it is to > be debunked by empiric study. Maybe Dr. Ken Mattox is on the right track (he > often is) when he says he sees no role whatsoever for these alternative IV > sites (central lines [prehospital], IOs, etc.). However, therapeutic > hypothermia seems promising and IC/IO access there is required. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 22, 2009 Report Share Posted February 22, 2009 Well another sounds good practice in EMS being found of no real benefit. It is sad that we have so many things done just because thats the way its always been done. It would be nice to see more studys done and have EMS start practicing fact based medicine rather than tradition. Thats for providing the information Dr Bledsoe. Renny Just my opinion for as little as its worth. > > Here is another interesting article (abstract) out of Lubbock published in > January 2009 Prehospital Emergency Care: > > > > Intraosseous Line Placement Does Not Improve Outcome in Adults with > Out-of-Hospital Cardiac Arrest C. Schutt, Bryson Bowman, Cihan Cevik, > Nadia Essa, Love Lee, n Macedo, Bruce Mowrey, Ratcliff, > L. Whitworth, Phy, Texas Tech University School of Medicine > > Objective. The purpose of this study was to determine if intraosseous (IO) > line placement improves outcome in adult patients with out-of- hospital > cardiac arrest. > > Methods. The study design was a retrospective cohort study. Inclusion > criteria were any patient 18 years or older with out-of-hospital cardiac > arrest transported to the emergency department (ED). The cohort was divided > based on the attempted placement of an IO line prior to ED arrival. IO > access was achieved using the EZ-IOR device. IO lines were placed in the > tibial tuberosity. Outcome measures were patient arrival at the ED with a > pulse and survival to hospital discharge. > > Results. 165 patients met the inclusion criteria for the study. IO placement > was attempted in 24 (14.5%) of 165 patients and was successful in 22 > patients (91.7%). Both failures were attributed to excess adipose tissue. In > patients who had IO access attempted, three (12.5%) of 24 arrived at the ED > with a pulse and zero (0%) survived to hospital discharge. In comparison, 39 > (27.7%) of 141 patients in which an IO line was not attempted arrived at the > ED with a pulse and seven (5.0%) survived to hospital discharge. The patient > groups did not differ significantly with regard to age, time of call to > ambulance arrival, body mass index, number of intravenous attempts, or time > on scene. After adjusting for the initial cardiac rhythm and if the arrest > was witnessed, univariate and multivariate regression analysis showed that > there was no significant difference between patient groups who had an IO > line placed and those who did not with regard to either arrival at the ED > with a pulse or survival to hospital discharge (p = 0.7, p = 0.6, > respectively). > > Conclusions. The results of this study suggest tibial IO placement is not > associated with improved survival in adult out-of-hospital cardiac arrest, > and adopting IO line placement as an alternative to direct venous access in > adult cardiac arrest cannot be recommended on the basis of improving patient > survival. > > > > This really doesn't surprise me as I we are finding no drug really effective > in cardiac arrest (and this is not a knock of the EZ-IO for I am sure the > results would be the same for the B.I.G. and similar technology). I have > felt that the role of the IO is limited (sepsis, cardiac arrest) and would > have thought that, if anything, there would have been an improvement in > cardiac arrest. I think the EZ-IO is a great device (made in Texas) but a > bit expensive. It will be interesting to watch the research roll in. For > me, the more intuitive a device or practice seems, the more likely it is to > be debunked by empiric study. Maybe Dr. Ken Mattox is on the right track (he > often is) when he says he sees no role whatsoever for these alternative IV > sites (central lines [prehospital], IOs, etc.). However, therapeutic > hypothermia seems promising and IC/IO access there is required. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 22, 2009 Report Share Posted February 22, 2009 Have there been any studies on IV therapy in CPR's? Lee From: texasems-l [mailto:texasems-l ] On Behalf Of spenair Sent: Sunday, February 22, 2009 1:27 PM To: texasems-l Subject: Re: Another hmmmm.... Well another sounds good practice in EMS being found of no real benefit. It is sad that we have so many things done just because thats the way its always been done. It would be nice to see more studys done and have EMS start practicing fact based medicine rather than tradition. Thats for providing the information Dr Bledsoe. Renny Just my opinion for as little as its worth. > > Here is another interesting article (abstract) out of Lubbock published in > January 2009 Prehospital Emergency Care: > > > > Intraosseous Line Placement Does Not Improve Outcome in Adults with > Out-of-Hospital Cardiac Arrest C. Schutt, Bryson Bowman, Cihan Cevik, > Nadia Essa, Love Lee, n Macedo, Bruce Mowrey, Ratcliff, > L. Whitworth, Phy, Texas Tech University School of Medicine > > Objective. The purpose of this study was to determine if intraosseous (IO) > line placement improves outcome in adult patients with out-of- hospital > cardiac arrest. > > Methods. The study design was a retrospective cohort study. Inclusion > criteria were any patient 18 years or older with out-of-hospital cardiac > arrest transported to the emergency department (ED). The cohort was divided > based on the attempted placement of an IO line prior to ED arrival. IO > access was achieved using the EZ-IOR device. IO lines were placed in the > tibial tuberosity. Outcome measures were patient arrival at the ED with a > pulse and survival to hospital discharge. > > Results. 165 patients met the inclusion criteria for the study. IO placement > was attempted in 24 (14.5%) of 165 patients and was successful in 22 > patients (91.7%). Both failures were attributed to excess adipose tissue. In > patients who had IO access attempted, three (12.5%) of 24 arrived at the ED > with a pulse and zero (0%) survived to hospital discharge. In comparison, 39 > (27.7%) of 141 patients in which an IO line was not attempted arrived at the > ED with a pulse and seven (5.0%) survived to hospital discharge. The patient > groups did not differ significantly with regard to age, time of call to > ambulance arrival, body mass index, number of intravenous attempts, or time > on scene. After adjusting for the initial cardiac rhythm and if the arrest > was witnessed, univariate and multivariate regression analysis showed that > there was no significant difference between patient groups who had an IO > line placed and those who did not with regard to either arrival at the ED > with a pulse or survival to hospital discharge (p = 0.7, p = 0.6, > respectively). > > Conclusions. The results of this study suggest tibial IO placement is not > associated with improved survival in adult out-of-hospital cardiac arrest, > and adopting IO line placement as an alternative to direct venous access in > adult cardiac arrest cannot be recommended on the basis of improving patient > survival. > > > > This really doesn't surprise me as I we are finding no drug really effective > in cardiac arrest (and this is not a knock of the EZ-IO for I am sure the > results would be the same for the B.I.G. and similar technology). I have > felt that the role of the IO is limited (sepsis, cardiac arrest) and would > have thought that, if anything, there would have been an improvement in > cardiac arrest. I think the EZ-IO is a great device (made in Texas) but a > bit expensive. It will be interesting to watch the research roll in. For > me, the more intuitive a device or practice seems, the more likely it is to > be debunked by empiric study. Maybe Dr. Ken Mattox is on the right track (he > often is) when he says he sees no role whatsoever for these alternative IV > sites (central lines [prehospital], IOs, etc.). However, therapeutic > hypothermia seems promising and IC/IO access there is required. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 22, 2009 Report Share Posted February 22, 2009 Have there been any studies on IV therapy in CPR's? Lee From: texasems-l [mailto:texasems-l ] On Behalf Of spenair Sent: Sunday, February 22, 2009 1:27 PM To: texasems-l Subject: Re: Another hmmmm.... Well another sounds good practice in EMS being found of no real benefit. It is sad that we have so many things done just because thats the way its always been done. It would be nice to see more studys done and have EMS start practicing fact based medicine rather than tradition. Thats for providing the information Dr Bledsoe. Renny Just my opinion for as little as its worth. > > Here is another interesting article (abstract) out of Lubbock published in > January 2009 Prehospital Emergency Care: > > > > Intraosseous Line Placement Does Not Improve Outcome in Adults with > Out-of-Hospital Cardiac Arrest C. Schutt, Bryson Bowman, Cihan Cevik, > Nadia Essa, Love Lee, n Macedo, Bruce Mowrey, Ratcliff, > L. Whitworth, Phy, Texas Tech University School of Medicine > > Objective. The purpose of this study was to determine if intraosseous (IO) > line placement improves outcome in adult patients with out-of- hospital > cardiac arrest. > > Methods. The study design was a retrospective cohort study. Inclusion > criteria were any patient 18 years or older with out-of-hospital cardiac > arrest transported to the emergency department (ED). The cohort was divided > based on the attempted placement of an IO line prior to ED arrival. IO > access was achieved using the EZ-IOR device. IO lines were placed in the > tibial tuberosity. Outcome measures were patient arrival at the ED with a > pulse and survival to hospital discharge. > > Results. 165 patients met the inclusion criteria for the study. IO placement > was attempted in 24 (14.5%) of 165 patients and was successful in 22 > patients (91.7%). Both failures were attributed to excess adipose tissue. In > patients who had IO access attempted, three (12.5%) of 24 arrived at the ED > with a pulse and zero (0%) survived to hospital discharge. In comparison, 39 > (27.7%) of 141 patients in which an IO line was not attempted arrived at the > ED with a pulse and seven (5.0%) survived to hospital discharge. The patient > groups did not differ significantly with regard to age, time of call to > ambulance arrival, body mass index, number of intravenous attempts, or time > on scene. After adjusting for the initial cardiac rhythm and if the arrest > was witnessed, univariate and multivariate regression analysis showed that > there was no significant difference between patient groups who had an IO > line placed and those who did not with regard to either arrival at the ED > with a pulse or survival to hospital discharge (p = 0.7, p = 0.6, > respectively). > > Conclusions. The results of this study suggest tibial IO placement is not > associated with improved survival in adult out-of-hospital cardiac arrest, > and adopting IO line placement as an alternative to direct venous access in > adult cardiac arrest cannot be recommended on the basis of improving patient > survival. > > > > This really doesn't surprise me as I we are finding no drug really effective > in cardiac arrest (and this is not a knock of the EZ-IO for I am sure the > results would be the same for the B.I.G. and similar technology). I have > felt that the role of the IO is limited (sepsis, cardiac arrest) and would > have thought that, if anything, there would have been an improvement in > cardiac arrest. I think the EZ-IO is a great device (made in Texas) but a > bit expensive. It will be interesting to watch the research roll in. For > me, the more intuitive a device or practice seems, the more likely it is to > be debunked by empiric study. Maybe Dr. Ken Mattox is on the right track (he > often is) when he says he sees no role whatsoever for these alternative IV > sites (central lines [prehospital], IOs, etc.). However, therapeutic > hypothermia seems promising and IC/IO access there is required. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 22, 2009 Report Share Posted February 22, 2009 Have there been any studies on IV therapy in CPR's? Lee From: texasems-l [mailto:texasems-l ] On Behalf Of spenair Sent: Sunday, February 22, 2009 1:27 PM To: texasems-l Subject: Re: Another hmmmm.... Well another sounds good practice in EMS being found of no real benefit. It is sad that we have so many things done just because thats the way its always been done. It would be nice to see more studys done and have EMS start practicing fact based medicine rather than tradition. Thats for providing the information Dr Bledsoe. Renny Just my opinion for as little as its worth. > > Here is another interesting article (abstract) out of Lubbock published in > January 2009 Prehospital Emergency Care: > > > > Intraosseous Line Placement Does Not Improve Outcome in Adults with > Out-of-Hospital Cardiac Arrest C. Schutt, Bryson Bowman, Cihan Cevik, > Nadia Essa, Love Lee, n Macedo, Bruce Mowrey, Ratcliff, > L. Whitworth, Phy, Texas Tech University School of Medicine > > Objective. The purpose of this study was to determine if intraosseous (IO) > line placement improves outcome in adult patients with out-of- hospital > cardiac arrest. > > Methods. The study design was a retrospective cohort study. Inclusion > criteria were any patient 18 years or older with out-of-hospital cardiac > arrest transported to the emergency department (ED). The cohort was divided > based on the attempted placement of an IO line prior to ED arrival. IO > access was achieved using the EZ-IOR device. IO lines were placed in the > tibial tuberosity. Outcome measures were patient arrival at the ED with a > pulse and survival to hospital discharge. > > Results. 165 patients met the inclusion criteria for the study. IO placement > was attempted in 24 (14.5%) of 165 patients and was successful in 22 > patients (91.7%). Both failures were attributed to excess adipose tissue. In > patients who had IO access attempted, three (12.5%) of 24 arrived at the ED > with a pulse and zero (0%) survived to hospital discharge. In comparison, 39 > (27.7%) of 141 patients in which an IO line was not attempted arrived at the > ED with a pulse and seven (5.0%) survived to hospital discharge. The patient > groups did not differ significantly with regard to age, time of call to > ambulance arrival, body mass index, number of intravenous attempts, or time > on scene. After adjusting for the initial cardiac rhythm and if the arrest > was witnessed, univariate and multivariate regression analysis showed that > there was no significant difference between patient groups who had an IO > line placed and those who did not with regard to either arrival at the ED > with a pulse or survival to hospital discharge (p = 0.7, p = 0.6, > respectively). > > Conclusions. The results of this study suggest tibial IO placement is not > associated with improved survival in adult out-of-hospital cardiac arrest, > and adopting IO line placement as an alternative to direct venous access in > adult cardiac arrest cannot be recommended on the basis of improving patient > survival. > > > > This really doesn't surprise me as I we are finding no drug really effective > in cardiac arrest (and this is not a knock of the EZ-IO for I am sure the > results would be the same for the B.I.G. and similar technology). I have > felt that the role of the IO is limited (sepsis, cardiac arrest) and would > have thought that, if anything, there would have been an improvement in > cardiac arrest. I think the EZ-IO is a great device (made in Texas) but a > bit expensive. It will be interesting to watch the research roll in. For > me, the more intuitive a device or practice seems, the more likely it is to > be debunked by empiric study. Maybe Dr. Ken Mattox is on the right track (he > often is) when he says he sees no role whatsoever for these alternative IV > sites (central lines [prehospital], IOs, etc.). However, therapeutic > hypothermia seems promising and IC/IO access there is required. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 22, 2009 Report Share Posted February 22, 2009 I strongly suspect that these results would apply to *all* types of vascular access, not just IO. Bledsoe, DO wrote: > > Here is another interesting article (abstract) out of Lubbock published in > January 2009 Prehospital Emergency Care: > > Intraosseous Line Placement Does Not Improve Outcome in Adults with > Out-of-Hospital Cardiac Arrest C. Schutt, Bryson Bowman, Cihan > Cevik, > Nadia Essa, Love Lee, n Macedo, Bruce Mowrey, Ratcliff, > L. Whitworth, Phy, Texas Tech University School of > Medicine > > Objective. The purpose of this study was to determine if intraosseous (IO) > line placement improves outcome in adult patients with out-of-hospital > cardiac arrest. > > Methods. The study design was a retrospective cohort study. Inclusion > criteria were any patient 18 years or older with out-of-hospital cardiac > arrest transported to the emergency department (ED). The cohort was > divided > based on the attempted placement of an IO line prior to ED arrival. IO > access was achieved using the EZ-IOR device. IO lines were placed in the > tibial tuberosity. Outcome measures were patient arrival at the ED with a > pulse and survival to hospital discharge. > > Results. 165 patients met the inclusion criteria for the study. IO > placement > was attempted in 24 (14.5%) of 165 patients and was successful in 22 > patients (91.7%). Both failures were attributed to excess adipose > tissue. In > patients who had IO access attempted, three (12.5%) of 24 arrived at > the ED > with a pulse and zero (0%) survived to hospital discharge. In > comparison, 39 > (27.7%) of 141 patients in which an IO line was not attempted arrived > at the > ED with a pulse and seven (5.0%) survived to hospital discharge. The > patient > groups did not differ significantly with regard to age, time of call to > ambulance arrival, body mass index, number of intravenous attempts, or > time > on scene. After adjusting for the initial cardiac rhythm and if the arrest > was witnessed, univariate and multivariate regression analysis showed that > there was no significant difference between patient groups who had an IO > line placed and those who did not with regard to either arrival at the ED > with a pulse or survival to hospital discharge (p = 0.7, p = 0.6, > respectively). > > Conclusions. The results of this study suggest tibial IO placement is not > associated with improved survival in adult out-of-hospital cardiac arrest, > and adopting IO line placement as an alternative to direct venous > access in > adult cardiac arrest cannot be recommended on the basis of improving > patient > survival. > > This really doesn't surprise me as I we are finding no drug really > effective > in cardiac arrest (and this is not a knock of the EZ-IO for I am sure the > results would be the same for the B.I.G. and similar technology). I have > felt that the role of the IO is limited (sepsis, cardiac arrest) and would > have thought that, if anything, there would have been an improvement in > cardiac arrest. I think the EZ-IO is a great device (made in Texas) but a > bit expensive. It will be interesting to watch the research roll in. For > me, the more intuitive a device or practice seems, the more likely it > is to > be debunked by empiric study. Maybe Dr. Ken Mattox is on the right > track (he > often is) when he says he sees no role whatsoever for these alternative IV > sites (central lines [prehospital], IOs, etc.). However, therapeutic > hypothermia seems promising and IC/IO access there is required. > > Quote Link to comment Share on other sites More sharing options...
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