Feasibility study of a novel intraosseous device in adult human cadavers
Sandeep Singh1, Praveen Aggarwal2, Rakesh Lodha3, Ramesh Agarwal3, Arun Kr Gupta4, Renu Dhingra5, Jayant Sitaram Karve6, Srinivas Kiran Jaggu6, Balram Bhargava1
1 Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
2 Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
3 Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
4 Department of Radio-Diagnosis, All India Institute of Medical Sciences, New Delhi, India
5 Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India
6 Stanford-India Biodesign Programme, All India Institute of Medical Sciences, New Delhi, India
Professor of Cardiology, Executive Director, Stanford-India Biodesign Program, Old OT Block, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029
Source of Support: None, Conflict of Interest: None
Background & objectives: Intraosseous (IO) access is an alternative to difficult intravenous (iv) access during emergency clinical situations. Existing IO solutions are expensive, require power supply and trained manpower; limiting their use in resource constrained settings. To address these limitations, a novel IO device has been developed. The objectives of this study were to evaluate functionality and safety of this device in adult human cadavers.
Methods: The ability of the IO device to penetrate the proximal and/or distal tibia was evaluated in three adult cadavers. Subjective parameters of loss of resistance, stable needle hold, easy needle withdrawal and any damage to the device were evaluated during the study. The insertion time was the objective parameter measured. Four sets of radiographs per insertion confirmed the position of the needle and identified complications.
Results: A single physician performed 12 IO access procedures using the same device. Penetration of proximal and/or distal tibia was achieved in all instances. It was successful in the first attempt in eight (66.7%) and during second attempt in the remaining. The mean time to insertion was 4.1 ± 3.1 sec. Appropriate insertion of needle in the intra-medullary space of bone was confirmed with radiological examination in 10 (83.3%) insertions. In two occasions after penetrating the cortical layer of bone, the device overshot the intra-medullary space, as detected by radiological examination. Device got bent during insertion in one instance. There was no evidence of needle breakage or bone fracture. The needle could be withdrawn effortlessly in all instances.
Interpretation & conclusions: The novel IO device could successfully penetrate the adult cadaver bones in most cases. Further studies are needed to confirm these results on a large sample.