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Comparison of three intraosseous access devices for resuscitation of term neonates: a randomised simulation study
  1. Alon Keller1,
  2. Amit Boukai1,
  3. Oren Feldman1,2,
  4. Raz Diamand1,2,
  5. Itai Shavit1,2
  1. 1 Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
  2. 2 Paediatric Emergency Department, Rambam Health Care Campus, Haifa, Israel
  1. Correspondence to Dr Itai Shavit, Rambam Health Care Campus, Haifa 31096, Israel; itai{at}


Objectives To compare the success rates and ease of use of three intraosseous (IO) access devices used in term neonates.

Design A three-arm randomised controlled simulation study was conducted.

Setting A simulation laboratory.

Participants Seventy-two paediatric residents completing their emergency department rotation as part of their residency training, and 20 paediatric specialists.

Intervention Using an animal bone model, the one-attempt success rate of the EZ-IO drill, the NIO-I needle and the Jamshidi needle was compared. Uncooked Cornish Hen bones were used because of their similarity in length and diameter to the bones of neonates. Participants were asked to record the perceived ease of use of their assigned device using a 5-point Likert Scale.

Main outcome measure The main outcome was the visualisation of flow emerging from the distal end of the bone, and perceived ease of use of the three IO devices.

Results The EZ-IO, NIO-I and Jamshidi groups included 30, 31 and 31 participants, respectively, with median (IQR) years of experience of 3 (2–5), 3 (2–6) and 4 (3–5) years. Participants had significantly lower one-attempt success rates with the EZ-IO drill than with the NIO-I and the Jamshidi needles (14 of 30 (46.7%) vs 24 of 31 (77.4%); p=0.016, and 14 of 30 (46.7%) vs 25 of 31 (80.7%); p=0.007, respectively). The median (IQR) ease-of-use score of the EZ-IO drill was higher than that of the NIO-I and Jamshidi needles (5 (4–5) vs 4 (4–5); p=0.008, and 5 (4–5) vs 4 (3–4); p=0.0004, respectively).

Conclusions Although easier to use, the EZ-IO drill demonstrated lower success rates than the IO needles in establishing IO access on a neonatal bone model.

  • neonatology
  • resuscitation

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Correction notice This article has been corrected since it was first published. The last sentence of the Limitations paragraph has been updated.

  • Contributors AK conducted the intraosseous tests, collected the data, prepared a first draft, made an early data analysis and critically revised the article. AB conducted the intraosseous tests, collected the data, prepared a first draft, made an early data analysis and critically revised the article. AB has equal contribution as first author. OF designed the study and analysis plan, and critically revised the article. RD coordinated enrolment of study participants, collected the data and critically revised the manuscript. IS conceived the idea for the study, designed the study and the analysis plan, carried out the statistical analysis, drafted the manuscript, and analysed and interpreted the data. IS has full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding Investigators purchased the drill and the needles from Teleflex Inc. (Morrisville, NC), PerSys Medical (Houston, TX), and Baxter HealthCare Corp. (Deerfield, IL).

  • Disclaimer The suppliers did not provide any funding and had no role in the design of the study; in the collection, analysis, and interpretation of the data; in the writing of the report; or in the decision to submit the paper for publication.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.