Intraosseous infusion: a ‘humerus’ subject?

The intraosseous (IO) route is frequently used to gain vascular access in adults who are in out-of-hospital cardiac arrest (OHCA). As yet, no optimal location for first attempt insertion has been established.

This observational study explores the first attempt success rate between proximal tibial and humeral IO insertion sites.

New patient care protocols were introduced in 2009 in Mecklenburg County, North Carolina stipulating that the intraosseous route should be used for initial vascular access for all OHCAs. Before participation in the study, paramedics were trained to use, and had to demonstrate proficiency with, the EZ-IO power driver.

Data was obtained from an existing OHCA registry. During the first month of the study, paramedics were instructed to use the humerus as the preferred IO insertion site followed by the tibia if unsuccessful; and vice versa during the second month.

In total, 88 patients ≥ 18 years old met the study's inclusion criteria and also received IO infusion. A total tibial insertion success rate of 84.5% overshadowed that of 40% for insertion into the humerus.