Observational studyThe journal of trauma and acute care surgery2018
The intraosseous have it: A prospective observational study of vascular access success rates in patients in extremis using video review.
Observational study in The journal of trauma and acute care surgery, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
23 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Prehospital coagulation management and fluid replacement therapy in patients with multiple and/or severe injuries - A systematic review and clinical practice guideline update.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2025Pooled it
- Does an instructional video as a stand-alone tool promote the acquisition of practical clinical skills? A randomised simulation research trial of skills acquisition and short-term retention.BMC medical education · 2024Trial
- Central venous catheters in prehospital care: Just because we can, does it mean we should?Transfusion · 2026Article
- Enhanced Trauma Video Review With Computer Vision: Trauma Resuscitation Phase Segmentation and Procedure Detection.Annals of surgery open : perspectives of surgical history, education, and clinical approaches · 2025Article
- When to choose intraosseous access in prehospital trauma care: A registry-based study from the Israel Defense Forces.Chinese journal of traumatology = Zhonghua chuang shang za zhi · 2025Article
- Changes in multidisciplinary perceptions of trauma video review following implementation of a novel program: let us go to the tape.Trauma surgery & acute care open · 2025Article
- Mind the GAHP: A novel protocol for improved vascular access in the hypotensive patient.Resuscitation plus · 2024Article
- The Efficacy of Intraosseous Access for Initial Resuscitation in Patients with Severe Trauma: A Retrospective Multicenter Study in South Korea.Journal of clinical medicine · 2024Article
- Intraosseous access in the resuscitation of patients with trauma: the good, the bad, the future.Trauma surgery & acute care open · 2024Review
- Article
- Future perspectives of higher standards for trauma teams' organization, support, and evaluation.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2023Review
- Hypertonic Saline Administration via Intraosseous Access During Symptomatic Hyponatremia.Cureus · 2023Article
- The Ability of Paramedics to Accurately Locate Correct Anatomical Sites for Intraosseous Needle Insertion.Cureus · 2023Article
- Evaluation of validity and reliability of video analysis and live observations to assess trauma team performance.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2022Observational
- Variation of in-hospital trauma team staffing: new resuscitation, new team.BMC emergency medicine · 2022Article
- Development and Characterization of an Ex Vivo Testing Platform for Evaluating Automated Central Vascular Access Device Performance.Journal of personalized medicine · 2022Article
- Evaluation of Local Pediatric Out-of-Hospital Cardiac Arrest and Emergency Services Response.Frontiers in pediatrics · 2022Article
- Article
- Leveraging Telemedicine for Quality Improvement Video Review of Critical ICU Events: A Novel Multidisciplinary Form of Education.Critical care explorations · 2021Article
- Intraosseous access in the resuscitation of trauma patients: a literature review.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2021Review
Corrections and comments
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Authors and funding
8 authors.
Funding
Abstract
backgroundQuick and successful vascular access in injured patients arriving in extremis is crucial to enable early resuscitation and rapid OR transport for definitive repair. We hypothesized that intraosseous (IO) access would be faster and have higher success rates than peripheral intravenous (PIV) or central venous catheters (CVCs).
methodsHigh-definition video recordings of resuscitations for all patients undergoing emergency department thoracotomy from April 2016 to July 2017 were reviewed as part of a quality improvement initiative. Demographics, mechanism of injury, access type, access location, start and stop time, and success of each vascular access attempt were recorded. Times to completion for access types (PIV, IO, CVC) were compared using Kruskal-Wallis test adjusted for multiple comparisons, while categorical outcomes, such as success rates by access type, were compared using χ test or Fisher's exact test.
resultsStudy patients had a median age of 30 years (interquartile range [IQR], 25-38 years), 92% were male, 92% were African American, and 93% sustained penetrating trauma. A total of 145 access attempts in 38 patients occurred (median, 3.8; SD, 1.4 attempts per patient). There was no difference between duration of PIV and IO attempts (0.63; IQR, 0.35-0.96 vs. 0.39 IQR, 0.13-0.65 minutes, adjusted p = 0.03), but both PIV and IO were faster than CVC attempts (3.2; IQR, 1.72-5.23 minutes; adjusted p < 0.001 for both comparisons). Intraosseous lines had higher success rates than PIVs or CVCs (95% vs. 42% vs. 46%, p < 0.001).
conclusionAccess attempts using IO are as fast as PIV attempts but are more than twice as likely to be successful. Attempts at CVC access in patients in extremis have high rates of failure and take a median of over 3 minutes. While IO access may not completely supplant PIVs and CVCs, IO access should be considered as a first-line therapy for trauma patients in extremis. LEVEL OF EVIDENCE: Therapeutic, level III.
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