Another hmmmm....

[Guest guest]

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.