American Journal of Emergency Medicine, Volume 30, Issue 7, Pages 1095-1099, September 2012
With the increase in the use of the intraosseous route for gaining venous access, especially in cardiac arrest and adult patients, the authors wanted to determine the first-attempt success rate at humeral placement of the EZ-IO by paramedics among prehospital adult cardiac arrest patients. The humerus has been considered as more difficult to access than other sites, possibly due to challenges in identifying the landmarks.
A retrospective cohort analysis of data prospectively collected over a 9-month period in San Antonio, Texas. The cohort consisted of adult cardiac arrest patients in whom the EZ-IO placement was attempted in the humerus by paramedics. The choice of vascular access was at the discretion of the paramedic and options included tibial or humeral EZ-IO and intravenous. Primary outcome is the percentage of successful placements (stable, flow, without extravasation) on first attempt. Secondary outcomes are overall successful placement, complications, and reason for failure. Data were collected during a post–cardiac arrest interview.
Humeral intraosseous (IO) access was attempted in 61% of 405 cardiac. First-attempt successful placement was 91%. Successful placement was 94%, considering the second attempts. In the unsuccessful attempts, 2% reported obesity as the cause (thought to be due to difficulty in locating the landmarks), 1% reported stable placement without flow, and 2% reported undocumented causes for failure. There were also 2% reports of successful placement with subsequent dislodgement during resuscitation or transport to hospital. Other studies have shown that humerus IO placement is at high risk of displacement, especially if usual length IO needles are used (longer 45 mm needles were used in this study for humeral access) but the report does not specify whether the Ez-IO securing device was used to reduce this risk.
The results of this study suggest a high degree of paramedic proficiency in establishment of IO access in the proximal humerus of the out-of-hospital cardiac arrest. Few complications suggest that proximal humeral IO access is a reliable method for vascular access in this patient population.