Perfusion intraosseuse: Le BIG c'est bien par voie humérale

Comparison of two intraosseous access devices in adult patients under resuscitation in the emergency department: A prospective, randomized study

 

Bernd A. Leidel^a, c, , , Chlodwig Kirchhoff^b, Volker Braunstein^b, Viktoria Bogner^b, Peter Biberthaler^band Karl-Georg Kanz^b

 

Resuscitation
Volume 81, Issue 8, August 2010, Pages 994-999

 

PREMIER POINT: Le BIG est aussi efficace que l'EZ-IO

Table 2. Success rates on first attempt and procedure times of the two different intraosseous devices BIG and EZ-IO for vascular access in adult emergency patients under resuscitation were not significantly different.

	Overall (n = 40)	BIG (n = 20)	EZ-IO (n = 20)	p (BIG versus EZ-IO)
Success rate on first attempt (%)	34/40 (85)	16/20 (80)	18/20 (90)	0.66
95% CI	73.9–96.1%	62.5–97.5%	76.9–100%
Mean procedure time ± SD (min)	2.0 ± 0.9	2.2 ± 1.0	1.8 ± 0.9	0.27
95% CI	1.7–2.3 min	1.7–2.6 min	1.4–2.2 min
Procedure time, min–max (min)	1.0–4.0	1.0–4.0	1.0–3.0

SECOND POINT: Le BIG une fois sur 2 en HUMERAL

Table 1. Patient characteristics: distribution of gender, age, obesity, trauma and insertion site in adult emergency patients under resuscitation were not significantly different between the two applied different intraosseous devices BIG and EZ-IO for vascular access.

 

	Overall (n = 40)	BIG (n = 20)	EZ-IO (n = 20)
Gender male (%)	27/40 (68)	13/20 (65)	14/20 (70)
Age ± SD (years) min–max (years)	48 ± 21 18–87	53 ± 22 18–87	43 ± 18 18–79
Obesity BMI > 30 kg/m2 (%)	7/40 (18)	3/20 (15)	4/20 (20)
Trauma (%)	29/40 (73)	15/20 (75)	14/20 (70)
Insertion site humeral (%)	22/40 (55)	11/20 (55)	11/20 (55)

TROISIEME POINT: Le BIG : Des échecs en tibial, des diifcultés pour sortir le mandrin à la main

 

In all four unsuccessful attempts with the BIG, the cannula did not penetrate the bone cortex, probably due to incorrect insertion site in three patients and excessive overlying soft tissue in one patient. All four unsuccessful attempts were tibial. In five patients the stylet was stuck within the cannula and could only be removed with a clamp. After removal of the stylet the administration of drugs and fluids through the cannula was possible without further complications and the IO insertion deemed successful.

Two unsuccessful attempts with the EZ-IO failed because of extravasation at the humeral head insertion site, probably due to incorrect insertion site and excessive overlying soft tissue.

Other technical problems like bending and breaking of the cannula or further relevant complications, likeinfection, extravasation, compartment syndrome, and cannula dislodgment or bleeding were not observed.