EZ-IO Versus Bone Gun for Access in Children
Date First Published:
February 2, 2011
Last Updated:
March 18, 2011
Report by:
Philip Dykes, ST4 (Leicester Royal Infirmary)
Search checked by:
Thunga Setty, Leicester Royal Infirmary
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.
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.
Search Details:
Sole search initially followed by assistance of a clinical librarian.
Outcome:
Twenty papers were found in total of which only one answered the clinical question.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Comparison of two mechanical intraosseous infusion devices: A pilot, randomized crossover trial Shavit I, Hoffman Y, Galbraith R, Waisman Y Sep-09 Ireland | 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 |
Author Commentary:
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.
Bottom Line:
The EZ-IO device may prove to be quicker and more successful at achieving intraosseous access than the bone injection gun.
References:
- Shavit I, Hoffman Y, Galbraith R, Waisman Y. Comparison of two mechanical intraosseous infusion devices: A pilot, randomized crossover trial