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Obtaining circulatory access whilst wearing personal protective equipment (PPE)

Three Part Question

When wearing [personal protective equipment] which is the[best method] for [obtaining circulatory access]

Clinical Scenario

A 20 year old man presents to the ED following exposure to an unknown chemical. On route to the ED he has a cardio-respiratory arrest. You are waiting to greet the patient wearing full PPE - you wonder what the best method of obtaining circulatory access is.

Search Strategy

PubMed and Cochrane libraries search until 2nd week of August 2009, [exp Personal Protective Equipment/ OR exp PPE] AND [exp circulatory OR vascular] AND [exp access]. Limit to humans AND English language.

Search Outcome

A total of 28 papers were found using the reported search, of which 1 represented the best evidence to answer the clinical question.

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
Suyama J, Knutsen CC, Northington WE, Hahn M, Hostler D
Pittsburgh, USA
Mannequin based study in a simulated HazMat scenario. EMT providers comparing antecubital fossae IV access with the EZ-IO system for anterior tibia IO access. Provider in PPE, mannequin not in PPE, time to access (14.0 vs. 46.0) seconds; p < 0.001 favours the IO approachSmall (provider)numbers, mannequin study in simulated conditions.


Only one paper was identified which answered the clinical question. Research into this rare but serious scenario is difficult to perform in "real life" situations. More work is required in this area but the evidence available points to the EZ-IO system being the quickest method of obtaining circulatory access in this scenario.

Clinical Bottom Line

The clinical bottom line is that the IO route of obtaining circulatory access was shown to be quicker than the intravenous route when wearing personal protective equipment.


  1. Suyama J, Knutsen CC, Northington WE, Hahn M, Hostler D IO versus IV access while wearing personal protective equipment in a HazMat scenario Prehosp Emerg Care 2007 Oct-Dec;11(4):467-72