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.
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

INTRODUCTIONIntraosseous access is an alternative to conventional intravenous access when access is difficult or impossible in the adult population. The EZ-IO is a novel intraosseous access device designed for use in adults, utilising a powered driver.

MATERIALS AND METHODSA prospective, observational study involving a convenience sample of 25 medical students, physicians and nursing staff recruited as study subjects to secure intraosseous access using the EZIO powered drill device, on a bone model.

RESULTSTwenty-three (92%) of the 25 study subjects required only 1 attempt at placing the EZ-IO. There were 24 (96%) successful placements of the EZ-IO. The average time taken to place the EZ-IO was 13.9 seconds. Twenty (87%) of 23 participants reported easier placement with the EZ-IO than an intravenous cannula. The average time taken for the physicians, nursing staff and medical students was 3.71 (+/- SD 1.70) seconds, 7.88 (+/- SD 4.02) seconds and 33.7 (24.5), respectively. Overall mean difficulty of insertion score (VAS) was 3.1 (+/- SD 1.9).

CONCLUSIONThe intraosseous access device evaluated in this study appears to be easy to use with high success rates of insertion with inexperienced participants. There is potential for use in the Emergency Department.

Adult ; Catheterization, Peripheral ; instrumentation ; Catheters, Indwelling ; Equipment Design ; Humans ; Infusions, Intraosseous ; instrumentation ; Professional Competence ; standards ; Prospective Studies ; Resuscitation ; methods ; Shock ; therapy

The purpose of hematopoietic stem cell transplantation by intra-bone marrow injection (IBM-HSCT) is to facilitate the homing of HSC. It has been recently proven in many animal experiments that different kinds of donor cells could efficiently home and engraft into the bone marrow by IBM-HSCT, which led to the rapid hemopoietic and immune recovery of recipients, preventing the development of GVHD, inducing the donor-specific tolerance in allogeneic organ transplantation, and promoting the survival rate of recipients. In this review, the effect of IBM-BMT and IBM-UCBT, the application of IBM injection technique in the study on HSC's biological characteristics, and its prospect for clinical HSCT were summarized.
Animals ; Bone Marrow ; Cord Blood Stem Cell Transplantation ; methods ; Hematopoietic Stem Cell Transplantation ; methods ; Humans ; Infusions, Intraosseous ; Peripheral Blood Stem Cell Transplantation ; methods