Comparison of three intraosseous access devices for resuscitation of term neonates: a randomised simulation study

Three different devices for intra-osseous access during were evaluated in a bone model intended to simulate insertion in term newborns. A total of 92 paediatricians were involved. Success rates were markedly different between devices. Objectives To compare the success rates and ease of use of three intraosseous (IO) access devices used in term neonates. Design A three-arm randomised controlled simulation study was conducted. Setting A simulation laboratory. Participants Seventy-two paediatric residents completing their emergency department rotation as part of their residency training, and 20 paediatric specialists. Intervention Using an animal bone model, the one-attempt success rate of the EZ-IO drill, the NIO-I needle and the Jamshidi needle was compared. Uncooked Cornish Hen bones were used because of their similarity in length and diameter to the bones of neonates. Participants were asked to record the perceived ease of use of their assigned device using a 5-point Likert Scale. Main outcome measure The main outcome was the visualisation of flow emerging from the distal end of the bone, and perceived ease of use of the three IO devices. Results The EZ-IO, NIO-I and Jamshidi groups included 30, 31 and 31 participants, respectively, with median (IQR) years of experience of 3 (2-5), 3 (2-6) and 4 (3-5) years. Participants had significantly lower one-attempt success rates with the EZ-IO drill than with the NIO-I and the Jamshidi needles (14 of 30 (46.7%) vs 24 of 31 (77.4%); p=0.016, and 14 of 30 (46.7%) vs 25 of 31 (80.7%); p=0.007, respectively). The median (IQR) ease-of-use score of the EZ-IO drill was higher than that of the NIO-I and Jamshidi needles (5 (4-5) vs 4 (4-5); p=0.008, and 5 (4-5) vs 4 (3-4); p=0.0004, respectively). Conclusions Although easier to use, the EZ-IO drill demonstrated lower success rates than the IO needles in establishing IO access on a neonatal bone model.

Automated summary

A study compared the success rates and ease of use of three intraosseous access devices on a neonatal bone model, finding that the EZ-IO drill had lower success rates but was easier to use compared to the NIO-I and Jamshidi needles.