Panamerican Journal of Trauma, Critical Care & Emergency Surgery

Register      Login

VOLUME 10 , ISSUE 3 ( September-December, 2021 ) > List of Articles

REVIEW ARTICLE

Comparison between Intraosseous and Central Venous Access in Adult Trauma Patients in the Emergency Room: A Systematic Review and Meta-analysis

Larissa B Loureiro, Ana Celia DCB Romeo, Marcelo AF Ribeiro Jr

Keywords : Emergency room, Intraosseous infusion, Trauma, Vascular access devices

Citation Information : Loureiro LB, Romeo AC, Ribeiro Jr MA. Comparison between Intraosseous and Central Venous Access in Adult Trauma Patients in the Emergency Room: A Systematic Review and Meta-analysis. Panam J Trauma Crit Care Emerg Surg 2021; 10 (3):113-120.

DOI: 10.5005/jp-journals-10030-1360

License: CC BY-NC 4.0

Published Online: 31-12-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

Background: Obtaining an efficient vascular access in a short-time is fundamental for the patient with hypovolemic shock in the emergency room. In case of peripheral venous access failure, the second option is not yet well defined. Objective: Critically appraise the literature on the use of intraosseous access and central venous access comparing these two interventions with respect to time to complete each of them, rate of success, and complications. Methods: The electronic databases used were MEDLINE / PubMed, PubMed Central, CAPES Platform, The Cochrane Library, EuroPMC, and Virtual Health Library (VHL). Literature reviews, conference proceedings, case reports, case series, comments, and correspondence were excluded, as were studies with children under 18 and a small sample. For the meta-analysis which estimated success in the first attempt, the Odds Ratios for success, the Mantel-Haenszel method was used for fixed effects. For the analysis of the execution time between procedures, the inverse variation method for fixed results was used. Meta-analysis calculations were performed using the Reviewer Manager 5.3 software. Results: A total of 144 studies were found, four of which were selected for the review, totaling 167 patients. There was superiority of intraosseous access in relation to central venous access with respect to the success rate in the first attempt (9.93; 95% CI 5.08–19.40; 0.00,001) and duration of the procedure (1.94; 95% CI 2.02–1.13; 0.00,001). All four studies comparing access found better performance and less time to perform intraosseous access compared to the central venous catheter. Conclusion: It is possible to determine that intraosseous vascular access is a safe, reliable, and a faster option in trauma patients in shock in the emergency room with inaccessible peripheral veins.


PDF Share
  1. Corporate Authors of the American College of Surgeons. Advanced Trauma Life Support (ATLS) .United States: Copyright; 10th ed. 2018.
  2. National Association of Emergency Medical Technicians. Prehospital Trauma Life Support (PHTLS).8th ed. United States. Jones & Bartlett Learning. 2017. 237-8 p.
  3. Phillips L, et al. Consortium on intraosseous vascular access in health care practice: recommendations for the use of intraosseous vascular access for emergent and nonemergent situations in various health care settings: a consensus paper. J Pediatr Nurs 2011; 26:85–90. DOI: 10.1016/j.jen.2010.09.001
  4. Moureau N, Lamperti M, Kelly L. Evidence-based consensus on the insertion of central venous access devices: definition of minimal requirements for training. Br J Anaesth 2013;110(3):347–356. DOI: 10.1093/bja/aes499
  5. Anson JA, Warner, M.D. Vascular Access in Resuscitation. Is There a Role for the Intraosseous Route? In: Lippincott W, Warner MD, editors. Anesthesiology 3rd ed. United States. 2014; v 120:p 1015–31.
  6. Fowler R, Gallagher JV, Isaacs SM, et al. The role of intraosseous vascular access in the out-of-hospital environment (resource document to NAEMSP position statement). Prehosp Emerg Care 2007;11(1):63–66. DOI: 10.1080/10903120601021036
  7. Santos D, Carron PN, Yersin B, et al. EZ-IO intraosseous device implementation in a pre-hospital emergency service: a prospective study and review of the literature. Resuscitation 2013;84(4):440–445.DOI: 10.1016/j.resuscitation.2012.11.006
  8. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses : the PRISMA statement. PLoS Med2009;6(7):e1000097. DOI: 10.1371/journal.pmed.1000097
  9. de Carvalho APV, Silva V, Grande AJ, et al. Avaliação do risco de viés de ensaios clínicos randomizados pela ferramenta da colaboração Cochrane. Diagn Tratamento 2013;18(1):38–44. DOI: https://doi.org/10.1136/bmj.d5928
  10. Malta M, Cardoso LO, Bastos FI, et al. Iniciativa STROBE: subsídios para a comunicação de estudos observacionais. Rev Saude Publica 2010;44(3):559–565.
  11. Wells G, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2013. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp,
  12. Pacheco R, Garcia C, Hosni N, et al. CONSORT Guidelines para publicação de estudos científicos. Parte 3: Como publicar ensaios clínicos. Diagn Tratamento 2017;22(4):169–175. DOI: 10.1136/bmj.c332
  13. Leidel BA, Kirchhoff C, Bogner V, et al. Comparison of intraosseous versus central venous vascular access in adults under resuscitation in the emergency department with inaccessible peripheral veins. Resuscitation 2012;83(1):40–45. DOI: 10.1016/j.resuscitation.2011.08.017.
  14. Leidel BA, Kirchhoff C, Bogner V, et al. Is the intraosseous access route fast and efficacious compared to conventional central venous catheterization in adult patients under resuscitation in the emergency department? A prospective observational pilot study. Patient Saf Surg 2009;3(1):24. DOI: 10.1186/1754-9493-3-24.
  15. Lee PM, Lee C, Rattner P, et al. Intraosseous versus central venous catheter utilization and performance during inpatient medical emergencies. Crit Care Med 2015;43(6):1233–1238. DOI: 10.1097/CCM.0000000000000942
  16. Chreiman KM, Ryan PM, Dumas MD, et al. The intraosseous have it: a prospective observational study of vascular access success rates in patients in extremis using video review. Trauma Acute Care Surg 2018;84(4):558–563. DOI: 10.1097/TA.0000000000001795
  17. Engels PT, Erdogan M, Widder SL, et al. Use of intraosseous devices in trauma: a survey of trauma practitioners in Canada, Australia and New Zealand. Can J Surg 2016;59(6):374-382. DOI: 10.1503/cjs.011215.
  18. Fulkerson J, Lowe R, Anderson T, et al. Effects of intraosseous tibial vs. intravenous vasopressin in a hypovolemic cardiac arrest model. West J Emerg Med 2016;17(2):222–228. DOI: 10.5811/westjem.2015.12.28825
  19. Smith RN, Nolan JP. Central venous catheters. BMJ 2013 347(6): 2–11. DOI: https://doi.org/10.1136/bmj.f6570
  20. Saugel B, Scheeren TWL, Teboul, J. Ultrasound-guided central venous catheter placement: a structured review and recommendations for clinical practice. Saugel Crit Care. 2017;21:225. DOI: 10.1186/s13054-017-1814-y
  21. Roldan CJ, Paniagua MD. Central venous catheter intravascular malpositioning: causes, prevention, diagnosis, and correction. West J Emerg Med 2015;16(5):658–664. DOI: 10.5811/westjem.2015.7.26248
  22. Weiser G, Hoffmann Y, Galbraith R. Current advances in intraosseous infusion—a systematic review. Resuscitation 2012;83(1):20–26. DOI: 10.1016/j.resuscitation.2011.07.020
  23. Laroche M. Intraosseous circulation from physiology to disease. Joint Bone Spine 2002;69(3):262–269. DOI: 10.1016/s1297-319x(02)00391-3
  24. Paxton JH, Knuth TE, Klausner HA. Proximal humerus intraosseous infusion: a preferred emergency venous access. J Trauma 2009; 67(3):606–611. DOI: 10.1097/TA.0b013e3181b16f42
  25. Leung J, Duffy M, Finckh A. Real-time ultrasonographically-guided internal jugular vein catheterization in the emergency department increases success rates and reduces complications: a randomized, prospective study. Ann Emerg Med 2006;48(5):540–547. DOI: 10.1016/j.annemergmed.2006.01.011
  26. Lemaster CH, Agrawal AT, Hou P. Systematic review of emergency department central venous and arterial catheter infection. Int J Emerg Med 2010;3(4):409–423. DOI: 10.1007/s12245-010-0225-5
  27. Bowley DM, Loveland J, Pitcher GJ. Tibial fracture as a complication of intraosseous infusion during pediatric resuscitation. J Trauma 2003;55(4):786 –787. DOI: 10.1097/01.TA.0000100170.61381.63
  28. Sanfilippo F, Noto A, Martucci G, et al. Central venous pressure monitoring via peripherally or centrally inserted central catheters: a systematic review and meta-analysis. J Vasc Access 2017;18(4):273–278. DOI: 10.5301/jva.5000749
  29. Simmons CM, Johnson NE, Perkin RM, et al. Intraosseous extravasation complication reports. Ann Emerg Med 1994;23(2):363–366. DOI: 10.1016/s0196-0644(94)70053-2
  30. Bjerkvig CK, Fosse TK, Apelseth TO, et al. Emergency sternal intraosseous access for warm fresh whole blood transfusion in damage control resuscitation. J Trauma Acute Care Surg 2018;84(6S Suppl 1):120–124. DOI: 10.1097/TA.0000000000001850
  31. Luck RP, Haines C, Mull CC.Intraosseous access. J Emerg Med 2010;39(4):468–475. DOI:10.1016/j.jemermed.2009.04.054
  32. Fuchs Z, Scaal, M, Haverkamp H, et al. Anatomical investigations on intraosseous access in stillborns – comparison of different devices and techniques. Resuscitation 2018;127:79tt–82. DOI: 10.1016/j.resuscitation.2018.04.003
  33. Petitpas F, Guenezan J, Vendeuvre T, et al. Use of intra-osseous access in adults: a systematic review. Crit Care 2016;20:100–102. DOI: 10.1186/s13054-016-1277-6
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.