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Best method of achieving IO access

Three Part Question

In [patients who require intraosseous access] is [a manual intraosseous access device or the EZ IO semi automatic intraosseous device] better at [achieving intraosseous access quickly, safely and easily]

Clinical Scenario

A 60 year old man presents to the emergency department in cardiorespiratory arrest. Numerous attempts to secure peripheral intravenous access are attempted without success. You decide to attempt intraosseous (IO) access to deliver resuscitation drugs and fluids. You have equal experience in using both a manual needle and the EZ IO battery powered IO insertion device for achieving IO access and wonder which method is best.

Search Strategy

Ovid SP Medline 1980 to July Week 3 2009. [exp EZ IO/OR semi automatic IO/OR semi automatic intraosseous] AND [manual IO/OR manual intraosseous/OR standard intraosseous/OR standard IO]. Limit to English.

Search Outcome

A total of 149 papers were found. Two of these papers were relevant to our three part question.

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
Brenner et al
84 participants testing 2 devices on adult human cadavers. Group 1 tested manual IO device (MAN-IO), group 2 tested semi automatic device (EZ IO)Randomised experimental trialNumber of attempts required for successful insertionLess attempts wit EZ IO (97.8% at first attempt v’s 78.5%) Cadavers used - difficult to assess patient related complications.
Insertion timeComparable
Occurrence of technical complicationsLess with EZ IO (0% v’s 15.4%)
User friendlinessEZ IO more user friendly
Matthew et al
245 patients in prehospital setting, 52 conventional IO, 193 EZ-IORetrospective before and after study (introduction of EZ-IO system)IO access success rateEZ-IO more successful (85% v’s 60%)Retrospective, operatives freshly trained on introduction of EZ-IO device.


The best evidence suggests that the EZ IO should be used in preference to the manual intraosseous needle in this clinical situation as it has a higher success rate, fewer technical complications, and is considered more user friendly. However other factors such as the clinical scenario, experience of the practitioner and availability of other devices not covered here should also be considered.

Clinical Bottom Line

The EZ IO device for intraosseous access should be used in preference to a manual intraosseous device where the practitioner is competent in both techniques and both devices are readily available.


  1. Brenner T, Bernhard M, Helm M et al. Comparison of two intraosseous infusion systems for adult emergency medical use Resuscitation 2008;78:314-9
  2. Mathew N, McGinnis-Hainsworth D, Megargel R, et al Trends in the usage of intraosseous access in the prehospital setting Prehospital Emergency Care 2007;11(1):130