Table 2
Author, date and countryPatient groupStudy type (level of evidence)OutcomesKey resultsStudy weaknesses
Calkins MDet al, 2000, USA31 special operations corpsmen testing 4 IO devices on cadavers; BIG, screw tip IO needles (2 other devices not relevant to the three part question so results not given)Randomised experimental trialSuccess rateBIG 94%, screw tip 97% (not significant)Using non-medical responders. By using cadavers there is no “clinical pressure” to achieve vascular access
Time to placementBIG 70 s (SD 33), screw tip 88s (33) (not significant)
Rank of preference(1–4)BIG average rank 2.3, screw tip average rank 2.5 (not significant)
Waisman M and Waisman D, 1997, USA19 patients for resuscitation in whom IV access could not be achieved within 10 minutes and 31 adults with fractures receiving regional anaesthesiaProspective case seriesSuccess rate100% successful placementObservational study with no comparisons. Small numbers. Lack of follow up in resuscitation group
Time to placementTime taken “1–2 minutes”
ComplicationsNone in 24 hours or 4 months for respective groups
Olsen D, 2002, USAAdult dogs randomised to either IO gun or a Jamshidi IO needle; 24 dogs in each groupPRCT (animal)Successful placement20/24 (83%) for BIG v 23/24 (96%) for the Jamshidi; p = 0.3475Animal study. Anaesthetised subjects. Direct relevance to humans questionable. Single operator did all procedures. They explain increased failure rate for BIG to be due to poor landmark identification rather than device failure
Average time for placement22.4 s for BIG v 42 s for Jamshidi