Comparison of the Fluid Resuscitation Rate with and without External Pressure Using Two Intraosseous Infusion Systems for Adult Emergencies, the CITRIN (Comparison of InTRaosseous infusion systems in emergency medicINe)-Study
Identifieur interne : 000A38 ( Main/Curation ); précédent : 000A37; suivant : 000A39Comparison of the Fluid Resuscitation Rate with and without External Pressure Using Two Intraosseous Infusion Systems for Adult Emergencies, the CITRIN (Comparison of InTRaosseous infusion systems in emergency medicINe)-Study
Auteurs : Niels Hammer [Nouvelle-Zélande, Allemagne] ; Robert Möbius [Allemagne] ; André Gries [Allemagne] ; Björn Hossfeld [Allemagne] ; Ingo Bechmann [Allemagne] ; Michael Bernhard [Allemagne]Source :
- PLoS ONE [ 1932-6203 ] ; 2015.
Abstract
Intraosseous infusion is recommended if peripheral venous access fails for cardiopulmonary resuscitation or other medical emergencies. The aim of this study, using body donors, was to compare a semi-automatic (EZ-IO®) device at two insertion sites and a sternal intraosseous infusion device (FASTR™).
Twenty-seven medical students being inexperienced first-time users were randomized into three groups using EZ-IO and FASTR. The following data were evaluated: attempts required for successful placement, insertion time and flow rates with and without external pressure to the infusion.
The first-pass insertion success of the EZ-IO tibia, EZ-IO humerus and FASTR was 91%, 77%, and 95%, respectively. Insertion times (MW±SD) did not show significant differences with 17±7 (EZ-IO tibia) vs. 29±42 (EZ-IO humerus) vs. 33±21 (FASTR), respectively. One-minute flow rates using external pressures between 0 mmHg and 300 mmHg ranged between 27±5 to 69±54 ml/min (EZ-IO tibia), 16±3 to 60±44 ml/min (EZ-IO humerus) and 53±2 to 112±47 ml/min (FASTR), respectively. Concerning pressure-related increases in flow rates, negligible correlations were found for the EZ-IO tibia in all time frames (c = 0.107–0.366; p≤0.013), moderate positive correlations were found for the EZ-IO humerus after 5 minutes (c = 0.489; p = 0.021) and strong positive correlations were found for the FASTR in all time frames (c = 0.63–0.80; p≤0.007). Post-hoc statistical power was 0.62 with the given sample size.
The experiments with first-time users applying EZ-IO and FASTR in body donors indicate that both devices may be effective intraosseous infusion devices, likely suitable for fluid resuscitation using a pressure bag. Variations in flow rate may limit their reliability. Larger sample sizes will prospectively be required to substantiate our findings.
Url:
DOI: 10.1371/journal.pone.0143726
PubMed: 26630579
PubMed Central: 4668027
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sort="Bernhard, Michael" uniqKey="Bernhard M" first="Michael" last="Bernhard">Michael Bernhard</name><affiliation wicri:level="3"><nlm:aff id="aff003"><addr-line>Emergency Department, University Hospital of Leipzig, Leipzig, Germany</addr-line></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Emergency Department, University Hospital of Leipzig, Leipzig</wicri:regionArea><placeName><region type="land" nuts="1">Saxe (Land)</region><region type="district" nuts="2">District de Leipzig</region><settlement type="city">Leipzig</settlement></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26630579</idno><idno type="pmc">4668027</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4668027</idno><idno type="RBID">PMC:4668027</idno><idno type="doi">10.1371/journal.pone.0143726</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">000332</idno><idno 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xml:lang="fr">Nouvelle-Zélande</country><wicri:regionArea>Department of Anatomy, University of Otago, Dunedin</wicri:regionArea><wicri:noRegion>Dunedin</wicri:noRegion></affiliation><affiliation wicri:level="3"><nlm:aff id="aff002"><addr-line>Institute of Anatomy, University of Leipzig, Faculty of Medicine, Leipzig, Germany</addr-line></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Institute of Anatomy, University of Leipzig, Faculty of Medicine, Leipzig</wicri:regionArea><placeName><region type="land" nuts="1">Saxe (Land)</region><region type="district" nuts="2">District de Leipzig</region><settlement type="city">Leipzig</settlement></placeName></affiliation></author><author><name sortKey="Mobius, Robert" sort="Mobius, Robert" uniqKey="Mobius R" first="Robert" last="Möbius">Robert Möbius</name><affiliation wicri:level="3"><nlm:aff id="aff002"><addr-line>Institute of Anatomy, University of Leipzig, Faculty of Medicine, Leipzig, Germany</addr-line></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Institute of Anatomy, University of Leipzig, Faculty of Medicine, Leipzig</wicri:regionArea><placeName><region type="land" nuts="1">Saxe (Land)</region><region type="district" nuts="2">District de Leipzig</region><settlement type="city">Leipzig</settlement></placeName></affiliation></author><author><name sortKey="Gries, Andre" sort="Gries, Andre" uniqKey="Gries A" first="André" last="Gries">André Gries</name><affiliation wicri:level="3"><nlm:aff id="aff003"><addr-line>Emergency Department, University Hospital of Leipzig, Leipzig, Germany</addr-line></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Emergency Department, University Hospital of Leipzig, Leipzig</wicri:regionArea><placeName><region type="land" nuts="1">Saxe (Land)</region><region type="district" nuts="2">District de Leipzig</region><settlement type="city">Leipzig</settlement></placeName></affiliation></author><author><name sortKey="Hossfeld, Bjorn" sort="Hossfeld, Bjorn" uniqKey="Hossfeld B" first="Björn" last="Hossfeld">Björn Hossfeld</name><affiliation wicri:level="3"><nlm:aff id="aff004"><addr-line>Department of Anaesthesiology and Intensive Care Medicine, Section Emergency Medicine, Federal Armed Forces Medical Hospital, Ulm, Germany</addr-line></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Anaesthesiology and Intensive Care Medicine, Section Emergency Medicine, Federal Armed Forces Medical Hospital, Ulm</wicri:regionArea><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Tübingen</region><settlement type="city">Ulm</settlement></placeName></affiliation></author><author><name sortKey="Bechmann, Ingo" sort="Bechmann, Ingo" uniqKey="Bechmann I" first="Ingo" last="Bechmann">Ingo Bechmann</name><affiliation wicri:level="3"><nlm:aff id="aff002"><addr-line>Institute of Anatomy, University of Leipzig, Faculty of Medicine, Leipzig, Germany</addr-line></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Institute of Anatomy, University of Leipzig, Faculty of Medicine, Leipzig</wicri:regionArea><placeName><region type="land" nuts="1">Saxe (Land)</region><region type="district" nuts="2">District de Leipzig</region><settlement type="city">Leipzig</settlement></placeName></affiliation></author><author><name sortKey="Bernhard, Michael" sort="Bernhard, Michael" uniqKey="Bernhard M" first="Michael" last="Bernhard">Michael Bernhard</name><affiliation wicri:level="3"><nlm:aff id="aff003"><addr-line>Emergency Department, University Hospital of Leipzig, Leipzig, Germany</addr-line></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Emergency Department, University Hospital of Leipzig, Leipzig</wicri:regionArea><placeName><region type="land" nuts="1">Saxe (Land)</region><region type="district" nuts="2">District de Leipzig</region><settlement type="city">Leipzig</settlement></placeName></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="sec001"><title>Introduction</title><p>Intraosseous infusion is recommended if peripheral venous access fails for cardiopulmonary resuscitation or other medical emergencies. The aim of this study, using body donors, was to compare a semi-automatic (EZ-IO<sup>®</sup>) device at two insertion sites and a sternal intraosseous infusion device (FASTR<sup>™</sup>).</p></sec><sec id="sec002"><title>Methods</title><p>Twenty-seven medical students being inexperienced first-time users were randomized into three groups using EZ-IO and FASTR. The following data were evaluated: attempts required for successful placement, insertion time and flow rates with and without external pressure to the infusion.</p></sec><sec id="sec003"><title>Results</title><p>The first-pass insertion success of the EZ-IO tibia, EZ-IO humerus and FASTR was 91%, 77%, and 95%, respectively. Insertion times (MW±SD) did not show significant differences with 17±7 (EZ-IO tibia) vs. 29±42 (EZ-IO humerus) vs. 33±21 (FASTR), respectively. One-minute flow rates using external pressures between 0 mmHg and 300 mmHg ranged between 27±5 to 69±54 ml/min (EZ-IO tibia), 16±3 to 60±44 ml/min (EZ-IO humerus) and 53±2 to 112±47 ml/min (FASTR), respectively. Concerning pressure-related increases in flow rates, negligible correlations were found for the EZ-IO tibia in all time frames (c = 0.107–0.366; p≤0.013), moderate positive correlations were found for the EZ-IO humerus after 5 minutes (c = 0.489; p = 0.021) and strong positive correlations were found for the FASTR in all time frames (c = 0.63–0.80; p≤0.007). Post-hoc statistical power was 0.62 with the given sample size.</p></sec><sec id="sec004"><title>Conclusions</title><p>The experiments with first-time users applying EZ-IO and FASTR in body donors indicate that both devices may be effective intraosseous infusion devices, likely suitable for fluid resuscitation using a pressure bag. Variations in flow rate may limit their reliability. 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