Trends in Prehospital Intraosseous Use Since 2001

Devin Price, MICP; MS, Charles Foat, PhD; Ron Lawler, BUS, NRP; Christopher Ford, MD; Angela Finney, MSN, CCEMTP, NREMT-P, EMSI; Erich Berg, BA; Amy Hammond, BS; Hanorah Vanni, BA; uke Stanke, PhDc; Susan Furness, PhDc

Introduction
It is unknown to what extent the use of intraosseous (IO) access in the prehospital setting has changed over time. Factors that may have impacted rates of IO use include: recommendations in the 2005 AHA Guidelines, advances in IO technology, and changes in scope of practice.

Objective
To determine whether proportion of patients on which insertion of an IO device was attempted in the prehospital environment has increased across all patient conditions since 2001.

Methods
Between January 2001 and December 2013, students reported their clinical experiences using Fisdap, a national web-based tracking system. Inclusion criteria consisted of student consent and instructor verification of student records. Data points queried were: all IV and IO attempts, year, age, indicators of cardiac arrest (primary impression/secondary impression, chest compressions, EPI IV/IO use), meds administered, and region of country. A logistic regression was fit to the data where the choice between IO and IV was the outcome variable and was compared to the year of the incident. In cases where both IO and IV were performed, the outcome was set to 0.5. Region, age, and indicator of cardiac arrest were used as control variables. This is a retrospective study utilizing prospectively collected, self-reported data. Some students or programs may have limited access to IOs which may have changed over time. This data includes observed IO interventions, which may impact the data.

Results
IO use was low and flat through 2006. Then there is a clear increase in the likelihood that a patient will receive an IO. As the chart illustrates, this escalated throughout the period. Cardiac arrest shows a very marked increase in the use of IOs over IVs.

  EstimateEffect Size
Category b95% CIexp(b)95% CI
 Intercept-8.90[-10.08, -7.72]  
Year20020.36[-1.11, 1.84]  
 20030.35[-0.98, 1.69]  
 20041.05[-0.20, 2.29]  
 20050.27[-1.03, 1.57]  
 20061.12[-0.09, 2.33]  
 20071.71[0.52, 2.90]5.52[1.68, 18.12]
 20082.43[1.25, 3.61]11.36[3.49, 36.98]
 20092.59[1.41, 3.76]13.29[4.09, 43.12]
 20103.05[1.88, 4.23]21.20[6.56, 68.53]
 20113.21[2.04, 4.39]24.83[7.68, 80.29]
 20123.37[2.20, 4.54]29.08[9.01, 93.89]
 20133.54[2.37, 4.71]34.45[10.68, 111.14]
RegionMidwest0.40[0.22, 0.58]1.50[1.25, 1.79]
 South0.11[-0.06, 0.28]  
 Unknown0.08[-0.32, 0.48]  
 West0.03[-0.14, 0.20]  
 Age-0.01[-0.01, -0.01]0.99[0.99, 0.99]

Conclusion
The proportion of patients on which insertion of an IO was attempted in the prehospital environment did increase across all patient conditions. Additional research is required to examine the factors which may have influenced this increase.