Efficacy of intraosseous access for trauma resuscitation: a systematic review and meta-analysis

被引:14
作者
Wang, Dong [1 ,2 ]
Deng, Lei [1 ,2 ,3 ]
Zhang, Ruipeng [1 ,2 ]
Zhou, Yiyue [4 ]
Zeng, Jun [1 ,2 ,3 ]
Jiang, Hua [1 ,2 ,3 ]
机构
[1] Univ Elect Sci & Technol China, Sichuan Prov Peoples Hosp, Inst Emergency & Disaster Med, 32 Yi Huan Lu Xi Er Duan, Chengdu 610072, Sichuan, Peoples R China
[2] Sichuan Translat Med Res Hosp, Chinese Acad Sci, Chengdu 610072, Peoples R China
[3] Univ Elect Sci & Technol China, Sichuan Prov Peoples Hosp, Sichuan Prov Clin Res Ctr Emergency & Crit Care Me, Chengdu 610072, Peoples R China
[4] Sorbonne Univ, Dept Biol, F-75005 Paris, France
关键词
Intraosseous access; Intravenous access; Trauma; Pre-hospital care; Resuscitation; VASCULAR ACCESS; CARDIAC-ARREST; INFUSION; CIRCULATION; SURVIVAL; DEVICES; MARROW; ADULTS; BLOOD; TIBIA;
D O I
10.1186/s13017-023-00487-7
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
BackgroundDuring medical emergencies, intraosseous (IO) access and intravenous (IV) access are methods of administering therapies and medications to patients. Treating patients in emergency medical situations is a highly time sensitive practice; however, research into the optimal access method is limited and existing systematic reviews have only considered out-of-hospital cardiac arrest (OHCA) patients. We focused on severe trauma patients and conducted a systematic review to evaluate the efficacy and efficiency of intraosseous (IO) access compared to intravenous (IV) access for trauma resuscitation in prehospital care.Materials and methodPubMed, Web of Science, Cochrane Library, EMBASE, ScienceDirect, banque de donnees en sante publique and CNKI databases were searched for articles published between January 1, 2000, and January 31, 2023. Adult trauma patients were included, regardless of race, nationality, and region. OHCA patients and other types of patients were excluded. The experimental and control groups received IO and IV access, respectively, in the pre-hospital and emergency departments for salvage. The primary outcome was success rate on first attempt, which was defined as secure needle position in the marrow cavity or a peripheral vein, with normal fluid flow. Secondary outcomes included mean time to resuscitation, mean procedure time, and complications.ResultsThree reviewers independently screened the literature, extracted the data, and assessed the risk of bias in the included studies; meta-analyses were then performed using Review Manager (Version 5.4; Cochrane, Oxford, UK). The success rate on first attempt was significant higher for IO access than for IV access (RR = 1.46, 95% CI [1.16, 1.85], P = 0.001). The mean procedure time was significantly reduced (MD = - 5.67, 95% CI [- 9.26, - 2.07], P = 0.002). There was no significant difference in mean time to resuscitation (MD = - 1.00, 95% CI [- 3.18, 1.17], P = 0.37) and complications (RR = 1.22, 95% CI [0.14, 10.62], P = 0.86) between the IO and IV groups.ConclusionThe success rate on first attempt of IO access was much higher than that of IV access for trauma patients, and the mean procedure time of IO access was significantly less when compared to IV access. Therefore, IO access should be suggested as an urgent vascular access for hypotensive trauma patients, especially those who are under severe shock.
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页数:14
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