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Three Part Question

In [children requiring intraosseous access] is the [EZ-IO better then the bone injection gun] at [achieving rapid access]?

Clinical Scenario

A child presents that requires rapid IO access after failed IV access. The paramedics want to use their bone gun to achieve access but the department only has the EZ-IO. You want to know which is most likely to achieve a successful and quick result.

Search Strategy

Medline (1950-9/2010) using the OVID interface. ({"ez io".mp} or {"ezio".mp} or {(intraos* adj2 gun*).mp} or {(bone* adj2 gun*).mp} or {(mechanical adj2 intraoss*).mp} or {(powered adj2 intraoss*).mp}). Limits: English language.

Embase (1980-week 37 2010). ({"ez io".mp} or {"ezio".mp} or {(intraos* adj2 gun*).mp} or {(mechanical adj2 intraoss*).mp} or {(powered adj2 intraoss*)} or {*"bone injection gun"} or {exp intraosseous drug administration} or {"bone injection gun*".mp}. Limited to humans.
Sole search initially followed by assistance of a clinical librarian.

Search Outcome

Twenty papers were found in total of which only one answered the clinical question.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Shavit I, Hoffman Y, Galbraith R, Waisman Y September 2009 Ireland	N/A	Randomised crossover trial. Looked at success of access and participants preferred choice of device (EZ-IO versus bone gun)	EZ-IO preferred device as most successful	Higher first attempt success rate with the EZ-IO	Small study group Subjective
			EZ-IO has more successful insertions	EZ-IO first group assessed it as being easier as compared to the BIG
				BIG first group found no difference in ease of use

Comment(s)

EZ-IO devices may be easier to insert as one can often feel the needle enter the medullary cavity (in the way of a ‘give’ in the cortex) and this may be one reason why they are preferred over bone guns. It would appear from the above paper that EZ-IO is the preferred device of choice. Further studies of the two devices are required to further evaluate which is best.

Clinical Bottom Line

The EZ-IO device may prove to be quicker and more successful at achieving intraosseous access than the bone injection gun.

References

1. Shavit I, Hoffman Y, Galbraith R, Waisman Y Comparison of two mechanical intraosseous infusion devices: A pilot, randomized crossover trial Elsevier 1029-1033