Abstract
Aim
Intraosseous (IO)-access plays an alternative route during resuscitation. Our study
was performed to investigate the successful rate of IO-access in preterm and term
stillborns using different devices and techniques.
Methods
The cadavers used were legal donations. 16 stillborns, median: 29.2 weeks (IQR 27.2–38.4)
were investigated. Two different needles (a: Butterfly needle, 21G, Venofix® Fa.Braun; b: Arrow®EZ-IO®15G, Teleflex, Dublin, Ireland) were used. Needles were inserted i: manually, using
a Butterfly needle; ii: manually, using EZ-IO® needle or iii: using a battery-powered semi-automatic drill (Arrow®EZ-IO®). Spectral-CT's were performed. The diameter of the corticalis was determined from
the CT-images. Successful hit rates with 95% confidence intervals (CI) and odds ratios
between the three methods were estimated using a generalised linear mixed model (GLMM).
Results
Estimated success rate was 61.1% (95%CI:39.7%–78.9%) for the Butterfly needle, 43.0%
(95%CI:23.4%–65.0%) for hand-twisted EZ-IO® screwing and 39.7% (95%CI:24.1–57.7%) for the semi-automatic drill (Arrow®EZ-IO®), all referring to an average diameter of the corticalis of 1.2 mm. The odds of a
correct position were 2.4 times higher (95%CI:0.8–7.6) when using the Butterfly needle
than with the drill. In contrast, the odds of correct positioning when inserting the
needle by hand were not significantly different from using the drill (odds ratio 1.1,
95%CI: 0.4–3.3). Neither of these effects nor the diameter of the corticalis with
an odds ratio near one were significant in the model. Median diameter of the bone
marrow cavity was 4.0 mm [IQR 3.3–4.7].
Conclusion
Intraosseous access for premature and neonatal infants could be best achieved by using
a manually twisted Butterfly needle.
Keywords
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Article info
Publication history
Published online: April 05, 2018
Accepted:
April 3,
2018
Received in revised form:
February 24,
2018
Received:
January 5,
2018
Footnotes
☆A Spanish translated version of the abstract of this article appears as Appendix in the final online version at https://doi.org/10.1016/j.resuscitation.2018.04.003.
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
