A Comparison of the Tibial Intraosseous Route With the Peripheral Intravenous Route for Fluid Resuscitation of Patients in Hypovolemic Shock

Aim and objectives Vascular access via the intraosseous (IO) route is increasingly utilized in patients with hypovolemic shock, especially when peripheral intravenous (IV) access is challenging due to collapsed veins. The present study aims to compare the tibial intraosseous route with the peripheral intravenous route for fluid resuscitation in adults with hypovolemic shock (Class >=II) in an emergency setting. The primary objective of this study is to compare the first attempt success rate and time taken to establish initial vascular access via the IO and IV routes. The secondary objective of this study is to compare the ease of establishment of the two routes using a five-point Likert scale. Material and methods The study included adult patients (18-65 years old) in hypovolemic shock (Class >=II) presenting to the emergency department, who required immediate vascular access. The patients were randomized to one of the two routes of vascular access: tibial intraosseous or peripheral intravenous. Outcome variables included the first attempt success rate, time taken to establish vascular access, and the ease of establishing the IO route (using the EZ-IO^® device (Teleflex, Morrisville, NC) as compared to the IV route. Results Out of 70 patients, 35 (50%, Group I) received proximal tibial vascular access via EZ-IO device, and 35 (50%, Group II) received peripheral intravenous access. First attempt success rate was significantly higher in Group I (100%) than in Group II (45.71%, (p<0.0001). The median time taken to establish vascular access (in seconds) was 77 (76-80) and 83 (49-99) in Groups I and II, respectively (p=0.830). This difference was statistically insignificant but clinically significant. The IO route was significantly easier to establish than the IV route as per a five-point Likert scale (p<0.0001). Conclusion Tibial intraosseous access has a higher first attempt success rate, is faster, and easier to establish than the peripheral intravenous route.