Objective: To evaluate the performance of prehospital providers in the use of the EZ-IO, a new adult intraosseous device. The results from this study were compared with the results from a previous field trial using the Pyng F.A.S.T. 1 system.
Methods: This study was a prospective, nonrandomized field trial. A total of 385 providers (EMT-Ps, EMT-Is, and RNs) from several emergency medical services agencies were enrolled. After completing a training program, the devices were deployed. Inclusion criteria for use of the device on a patient included: age ≥ 18 years, no intravenous (IV) access available, multiple failures at IV attempts, and patient in extremis. Exclusion criteria included: age <18 years, tibia or femur fracture, knee replacement, osteoporosis or tumor in the leg, infection at the insertion site, or inability to locate landmarks. Data collection continued through December 2005. This mid-term analysis examined data from the first 44 cases regarding insertion success, provider comfort, device function evaluation, and recommendation of future use of the device. Statistical analysis using chi-square and Fisher exact tests compared these values with those obtained from the Pyng F.A.S.T. 1 trial.
Results: 38 of the 44 insertions currently available for analysis were successful (86%). Three failures were device-related and three were provider-related. The success rate from the previous trial using the Pyng F.A.S.T. 1 system was 70% (28/40). Using the Fisher exact test, a significant difference in insertion success rates was seen (p = 0.041). No difference in provider comfort (χ2 = 0.087, p = 0.77), device performance evaluation (χ2 = 0.87, p = 0.35), or recommendation for continued use (χ2 = 1.26, p = 0.26) was shown between the two devices.
Conclusions: The EZ-IO appears to be a superior device with regard to insertion success compared with the Pyng F.A.S.T. 1, but equivalent in terms of provider comfort, provider device performance evaluation, and provider recommendations for use in the field. The use of an intraosseous device as a first-line intervention may be warranted for resuscitation of adult patients in extremis. Further research is necessary to evaluate this hypothesis.