Comparison of intraosseous versus central venous vascular access in adults under resuscitation in the emergency department with inaccessible peripheral veins.

Leidel, BA; Kirchhoff, C; Bogner, V; Braunstein, V; Biberthaler, P; Kanz, KG

doi:10.1016/j.resuscitation.2011.08.017

2012

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Title:: Comparison of intraosseous versus central venous vascular access in adults under resuscitation in the emergency department with inaccessible peripheral veins.
Document type:: Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't; Article
Author(s):: Leidel, BA; Kirchhoff, C; Bogner, V; Braunstein, V; Biberthaler, P; Kanz, KG
Abstract:: Current European Resuscitation Council (ERC) guidelines recommend intraosseous (IO) vascular access, if intravenous (IV) access is not readily available. Because central venous catheterisation (CVC) is an established alternative for in-hospital resuscitation, we compared IO access versus landmark-based CVC in adults with difficult peripheral veins.In this prospective observational study we investigated success rates on first attempt and procedure times of IO access versus central venous catheterisation (CVC) in adults (>= 18 years of age) with inaccessible peripheral veins under trauma or medical resuscitation in a level I trauma centre emergency department.Forty consecutive adults under resuscitation were analysed, each receiving IO access and CVC simultaneously. Success rates on first attempt were significantly higher for IO cannulation than CVC (85% versus 60%, p=0.024) and procedure times were significantly lower for IO access compared to CVC (2.0 versus 8.0 min, p<0.001). As for complications, failure of IO access was observed in 6 patients, while 2 or more attempts of CVC were necessary in 16 patients. No other relevant complications like infection, bleeding or pneumothorax were observed.IO vascular access is a reliable bridging method to gain vascular access for in-hospital adult patients under resuscitation with difficult peripheral veins. Moreover, IO access is more efficacious with a higher success rate on first attempt and a lower procedure time compared to landmark-based CVC.
Journal title abbreviation:: Resuscitation
Year:: 2012
Journal volume:: 83
Journal issue:: 1
Pages contribution:: 40-5
Fulltext / DOI:: doi:10.1016/j.resuscitation.2011.08.017
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/21893125
Print-ISSN:: 0300-9572
TUM Institution:: Klinik und Poliklinik für Unfallchirurgie
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Klinik und Poliklinik für Unfallchirurgie (Prof. Biberthaler)2012