{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T09:27:48Z","timestamp":1766050068715,"version":"3.37.3"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"11-12","license":[{"start":{"date-parts":[[2022,7,22]],"date-time":"2022-07-22T00:00:00Z","timestamp":1658448000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,11,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Intraosseous (IO) needle insertion is a key adjunctive procedure in the care of critically ill and injured patients in a variety of settings, including the battlefield. The NIO is a new, fully disposable, single-piece, IO device with potential practical advantages under austere conditions. We sought to compare the efficacy and safety of the NIO to an established, well-studied device, the EZIO, when used for resuscitative vascular access in the emergency department (ED).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Retrospective, single-center, quasi-experimental, before-and-after, observational cohort study performed at an urban, tertiary-care hospital ED among adult patients receiving IO access during resuscitation. The before\/NIO period lasted from July 1, 2019, to May 31, 2020, and the EZIO\/after period from June 1, 2020, to April 30, 2021. Patient demographics, prehospital treatment, ED presentation, characteristics and results of IO insertion(s), potential procedure-associated adverse events, and ED and hospital outcomes were abstracted from the medical record. The primary outcome, rate of first-pass success (FPS), was compared between the NIO and EZIO periods using multivariable regression after adjustment for potential confounding factors.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We enrolled 63 total patients\/66 limbs (mean age 61\u2009\u00b1\u200918, 51% female), 34 patients\/35 limbs during the NIO period and 29 patients\/31 limbs during the EZIO period. The most common reason for IO insertion was cardiac arrest (40\/63, 63%), followed by respiratory failure, trauma, and sepsis. The majority of IO insertions were performed at the proximal tibia (58\/66, 88%) by senior emergency medicine residents or faculty. The overall rate of FPS was 53\/66 (80%), 24\/35 (69%) with the NIO compared to 29\/31 (94%) with the EZIO. After multivariable modeling, the odds of FPS with the NIO vs. the EZIO was 0.19 (95% CI, 0.01\u20131.5, P\u2009=\u2009.16). Procedure-related adverse events were infrequent in both groups. In-hospital mortality was 45\/63 (71%).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>We found that the NIO device was associated with a lower-than-expected rate of FPS compared to the EZIO device, although not significantly different after adjusting for between-group imbalances and considering limitations in the study design. Further, prospective research into the efficacy and safety of the NIO is needed before clinical use can be encouraged.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usac126","type":"journal-article","created":{"date-parts":[[2022,7,23]],"date-time":"2022-07-23T15:38:38Z","timestamp":1658590718000},"page":"3423-3431","source":"Crossref","is-referenced-by-count":4,"title":["Comparison of the NIO and EZIO for Resuscitative Vascular Access in the Emergency Department: A Quasi-Experimental, Before-and-After Study"],"prefix":"10.1093","volume":"188","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0960-4412","authenticated-orcid":false,"given":"Byron C","family":"Drumheller","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Einstein Healthcare Network, Einstein Medical Center Philadelphia , Philadelphia, PA 19141, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew D","family":"Edgar","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Einstein Healthcare Network, Einstein Medical Center Philadelphia , Philadelphia, PA 19141, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meghan K","family":"Tape","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Einstein Healthcare Network, Einstein Medical Center Philadelphia , Philadelphia, PA 19141, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Don","family":"Vongviphut","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Einstein Healthcare Network, Einstein Medical Center Philadelphia , Philadelphia, PA 19141, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph P","family":"Herres","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Einstein Healthcare Network, Einstein Medical Center Philadelphia , Philadelphia, PA 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