When to choose intraosseous access in prehospital trauma care: A registry-based study from the Israel Defense Forces.

Mor RITTBLAT; Nir TSUR; Adi KARAS; Sami GENDLER; Zivan BEER; Irina RADOMISLENSKY; Ofer ALMOG; Avishai M TSUR; Guy AVITAL; Tomer TALMY

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When to choose intraosseous access in prehospital trauma care: A registry-based study from the Israel Defense Forces.

Author: Mor RITTBLAT ¹ ; Nir TSUR ² ; Adi KARAS ³ ; Sami GENDLER ³ ; Zivan BEER ⁴ ; Irina RADOMISLENSKY ⁵ ; Ofer ALMOG ⁴ ; Avishai M TSUR ⁶ ; Guy AVITAL ⁷ ; Tomer TALMY ⁸
Author Information

1. Israel Defense Forces Medical Corps, Tel Hashomer, Ramat Gan, 02149, Israel; Department of Plastic and Reconstructive Surgery, Hadassah Hebrew University Medical Centre, Jerusalem, 12272, Israel; Department of Military Medicine and "Tzameret" Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, 12272, Israel. Electronic address: mor.rittblat@mail.huji.ac.il.
2. Israel Defense Forces Medical Corps, Tel Hashomer, Ramat Gan, 02149, Israel; Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Tel Aviv University, Petach Tiqva, 4941492, Israel.
3. Israel Defense Forces Medical Corps, Tel Hashomer, Ramat Gan, 02149, Israel.
4. Israel Defense Forces Medical Corps, Tel Hashomer, Ramat Gan, 02149, Israel; Department of Military Medicine and "Tzameret" Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, 12272, Israel.
5. Israel Defense Forces Medical Corps, Tel Hashomer, Ramat Gan, 02149, Israel; The Israel National Center for Trauma & Emergency Medicine Research, Gertner Institute of Epidemiology and Health Policy Research, Tel Hashomer, Ramat Gan, 52621, Israel.
6. Israel Defense Forces Medical Corps, Tel Hashomer, Ramat Gan, 02149, Israel; Department of Military Medicine and "Tzameret" Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, 12272, Israel; Department of Internal Medicine B, Sheba Medical Center, Tel-Hashomer, 52621, Israel.
7. Israel Defense Forces Medical Corps, Tel Hashomer, Ramat Gan, 02149, Israel; Division of Anesthesia, Intensive Care & Pain Management, Tel-Aviv Sourasky Medical Center, Tel-Aviv, 6423906, Israel.
8. Israel Defense Forces Medical Corps, Tel Hashomer, Ramat Gan, 02149, Israel; Department of Military Medicine and "Tzameret" Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, 12272, Israel; Division of Anesthesia, Intensive Care & Pain Management, Tel-Aviv Sourasky Medical Center, Tel-Aviv, 6423906, Israel.
Publication Type:Journal Article
Keywords: Intraosseous; Military; Prehospital; Trauma; Vascular access
MeSH: Humans; Male; Infusions, Intraosseous/methods*; Female; Registries; Israel; Emergency Medical Services/methods*; Adult; Young Adult; Wounds and Injuries/mortality*; Military Personnel; Resuscitation/methods*; Middle Aged; Shock, Hemorrhagic/therapy*; Cohort Studies
From: Chinese Journal of Traumatology 2025;28(4):294-300
CountryChina
Language:English
Abstract: PURPOSE:Prompt vascular access is crucial for resuscitating bleeding trauma casualties in prehospital settings but achieving peripheral intravenous (PIV) access can be challenging during hemorrhagic shock due to peripheral vessel collapse. Early intraosseous (IO) device use is suggested as an alternative. This study examines injury characteristics and factors linked to IO access requirements.
METHODS:A registry-based cohort study from the Israel Defense Forces Trauma Registry (2010 - 2023) included trauma casualties receiving PIV or IO access prehospital. Casualties who had at least one documented PIV or IO access attempt were included, while those without vascular access were excluded. Casualties requiring both PIV and IO were classified in the IO group. Univariable logistic regression assessed the factors associated with IO access. Results were reported as odds ratios (OR) with 95% confidence intervals (CI), and significant difference was set at p < 0.05.
RESULTS:Of 3462 casualties (86.3% male, the median age: 22 years), 3287 (94.9%) received PIV access and 175 (5.1%) had IO access attempts. In the IO group, 30.3% received freeze-dried plasma and 23.4% received low titer group O whole blood, significantly higher than that in the PIV group. Prehospital mortality was 35.0% in the IO group. Univariable analysis showed significant associations with IO access for increased PIV attempts (OR = 1.69; 95% CI: 1.34 - 2.13) and signs of profound shock (OR = 11.0; 95% CI: 5.5 - 23.3).
CONCLUSION:Profound shock signs are strongly linked to the need for IO access in prehospital settings with each successive PIV attempt increasing the likelihood of requiring IO conversion. IO access often accompanies low titer group O whole blood or freeze-dried plasma administration and higher prehospital mortality, indicating its use in emergent resuscitation situations. Early IO consideration is advised for trauma casualties with profound shock.