A Simulation Study Comparing Intraosseous Devices for Neonatal Resuscitation: A Three-Arm Randomized Controlled Trial

Introduction: The intraosseous (IO) access has proven to be a lifesaving procedure in the critically ill infant. In newborns, umbilical venous catheterization is a common practice, however this is not an available option in older neonates who no longer have an umbilical cord access point. IO access is the preferred route at that age.

Objective: To compare the success rates of the three most commonly used IO devices in neonates.

Methods: A three-arm randomized controlled simulation study was performed. The one-attempt success rate of the NIO-I needle, the Jamshidi needle, and the EZIO battery drill were compared. Uncooked Cornish hen bones were used as the study model. All attempts were filmed by a video camera. Successful placement was defined as the visualization of flow from the marrow cavity. Study participants were Pediatricians and Pediatric residents. Participants recorded their ranking of the “ease of use” of each device.

Results: Participants had a significantly higher one-attempt success rate with the Jamshidi needle and the NIO-I needle than with the EZIO drill (22/27 (81.5%) vs 12/27 (44.4%), p =0.010, and 22/28 (78.6%) vs 12/27 (44.4%), p =0.011; respectively). Median ease-of-use Likert-scale scores of the Jamshidi and the NIO-I needles and the EZIO drill were 4 (interquartile range [IQR] 3.5–4), 4 (IQR 4–5) and 5 (IQR = 4–5); respectively.

Conclusions: The Jamshidi and NIO-I needles demonstrated higher success rates than the EZIO drill. The low success rates of the EZIO drill suggest that it should not be used in neonates.