IO's?...good for?

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A few brief thoughts on the whole IO debate from a lowly paramedic:

In my system we use them prehospitally "If a peripheral IV cannot be 
established after two attempts or within 60–90 seconds of elapsed time 
and in adult and pediatric patients who present with one or more of the 
following clinical conditions:
1. Cardiac arrest.
2. Hemodynamic instability (BP <90 mmHg and clinical signs of shock).
3. Imminent respiratory failure.
4. Status epilepticus with prolonged seizure activity greater than 10 
minutes, and refractory to IM anticonvulsants.
5. Toxic conditions requiring immediate IV access for antidote."

There is also a provision stating that IOs can be placed without IV 
attempts in "cases of cardiopulmonary or traumatic arrest, in which it 
may be obvious that attempts at placing an IV would likely be 
unsuccessful and or too time consuming, resulting in a delay of 
life-saving fluids or drugs."

We use the EZ-IO system, as well as "old-fashioned" IO for pediatrics. 
Most of the IOs I've seen placed have been in cardiac arrest patients. 
Usually we're able to place a peripheral or external jugular IV in most 
patients.

I tend to agree that IO is of limited utility in traumatic emergencies 
except in the case of needing to control an airway. In my experience, 
and anecdotally from other medics, IOs do not flow fluid very well. As 
far as I know my system has not yet done any restrospective chart 
review of IO usage in terms of case types, successes, etc.

I don't see any reason to have IO in the hospital environment where 
central lines can be placed.

Garth Melnick
NREMT-Paramedic

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