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Eur J Pediatr. 2017 Jul;176(7):865-871. doi: 10.1007/s00431-017-2922-z. Epub 2017 May 12.

Comparison of four different intraosseous access devices during simulated pediatric resuscitation. A randomized crossover manikin trial.

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MEDITRANS The Voivodship Emergency Medical Service and Sanitary Transport, Warsaw, Poland.
Department of Emergency Medicine, Medical University of Warsaw, Lindleya 4 Street, 02-005, Warsaw, Poland.
Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland.
Department of Emergency Medicine and Disaster, Medical University Bialystok, Bialystok, Poland.
Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.
Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH, USA.


The aim of the study was to compare the success rate, procedure time, and user satisfaction of pediatric NIO™ compared to Pediatric BIG®, EZ-IO®, and Jamshidi intraosseous access devices. This was a randomized, crossover manikin trial with 87 paramedics. The correct location of intraosseous access when using NIO, BIG, EZ-IO, and Jamshidi was varied and was respectively 100, 90, 90, and 90%. The time required to obtain intravascular access (time T1) in the case of NIO, BIG, EZ-IO, and Jamshidi was varied and amounted to 9 s [IQR, 8-12] for NIO, 12 s [IQR, 9-16] for BIG, 13.5 s [IQR, 11-17] for the EZ-IO, and 15 s [IQR, 13-19] for Jamshidi. The paramedics evaluated each device on the subjective ease with which they performed the procedures. The intraosseous device, which proved the easiest to use was NIO, which in the case of CPR received a median rating of 1.5 (IQR, 0.5-1.5) points.


Our study found that NIO® is superior to BIG®, EZ-IO®, and Jamshidi. NIO® achieved the highest first attempt success rate. NIO® also required the least time to insert and easiest to operate even by novice users. Further study is needed to test our findings in cadavers or human subjects. Based on our findings, NIO® is a promising intraosseous device for use in pediatric resuscitation. What is Known: • Venous access in acutely ill pediatric patients, such as those undergoing cardiopulmonary resuscitation, is needed for prompt administration of drugs and fluids. • Intraosseous access is recommended by American Heart Association and European Resuscitation council if vascular access is not readily obtainable to prevent delay in treatment. What is New: • This simulated pediatric resuscitation compared performance of four commercially available pediatric intraosseous devices in a manikin model. • NIO® outperformed BIG®, EZ-IO®, and Jamshidi in first attempt success rates and time of procedure among novice users.


Cardiopulmonary resuscitation; Intraosseous access; Paramedic; Pediatric; Simulation

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