Elderly Male With Out-of-Hospital Cardiac Arrest

A 92-year-old man with an out-of-hospital cardiac arrest arrived at the emergency department, and, because of challenging intravenous catheter access, we inserted a proximal humeral intraosseous catheter. We used transesophageal echocardiography and observed visible echogenic bubbles reaching the right atrium after the infusion of a saline solution bolus (Figure, Video 1 [available at http://www.annemergmed.com]).DiagnosisBubble saline solution test for catheter placement confirmation.1Duran-Gehring P.E. Guirgis F.W. McKee K.C. et al.The bubble study: ultrasound confirmation of central venous catheter placement.Am J Emerg Med. 2015; 33: 315-319Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar During mechanical cardiopulmonary resuscitation in this patient, it took 3 seconds for the medication to reach the right heart chambers from the proximal humeral intraosseous site, similar to the 2.4-second duration observed in human volunteers.2Montez D.F. Puga T. Miller L. et al.133 intraosseous infusions from the proximal humerus reach the heart in less than 3 seconds in human volunteers.Ann Emerg Med. 2015; 66: S47Abstract Full Text Full Text PDF Google Scholar In out-of-hospital cardiac arrest, intraosseous access may allow rapid administration of medications1Duran-Gehring P.E. Guirgis F.W. McKee K.C. et al.The bubble study: ultrasound confirmation of central venous catheter placement.Am J Emerg Med. 2015; 33: 315-319Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar, 2Montez D.F. Puga T. Miller L. et al.133 intraosseous infusions from the proximal humerus reach the heart in less than 3 seconds in human volunteers.Ann Emerg Med. 2015; 66: S47Abstract Full Text Full Text PDF Google Scholar, 3Tan B.K.K. Chin Y.X. Koh Z.X. et al.Clinical evaluation of intravenous alone versus intravenous or intraosseous access for treatment of out-of-hospital cardiac arrest.Resuscitation. 2021; 159: 129-136Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar, 4Kawano T. Grunau B. Scheuermeyer F.X. et al.Intraosseous vascular access is associated with lower survival and neurologic recovery among patients with out-of-hospital cardiac arrest.Ann Emerg Med. 2018; 71: 588-596Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar, 5Daya M.R. Leroux B.G. Dorian P. et al.Survival after intravenous versus intraosseous amiodarone, lidocaine, or placebo in out-of-hospital shock-refractory cardiac arrest.Circulation. 2020; 141: 188-198Crossref PubMed Scopus (25) Google Scholar; however, retrospective analyses have reported inferior survival compared to intravenous access.3Tan B.K.K. Chin Y.X. Koh Z.X. et al.Clinical evaluation of intravenous alone versus intravenous or intraosseous access for treatment of out-of-hospital cardiac arrest.Resuscitation. 2021; 159: 129-136Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar, 4Kawano T. Grunau B. Scheuermeyer F.X. et al.Intraosseous vascular access is associated with lower survival and neurologic recovery among patients with out-of-hospital cardiac arrest.Ann Emerg Med. 2018; 71: 588-596Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar, 5Daya M.R. Leroux B.G. Dorian P. et al.Survival after intravenous versus intraosseous amiodarone, lidocaine, or placebo in out-of-hospital shock-refractory cardiac arrest.Circulation. 2020; 141: 188-198Crossref PubMed Scopus (25) Google Scholar A 92-year-old man with an out-of-hospital cardiac arrest arrived at the emergency department, and, because of challenging intravenous catheter access, we inserted a proximal humeral intraosseous catheter. We used transesophageal echocardiography and observed visible echogenic bubbles reaching the right atrium after the infusion of a saline solution bolus (Figure, Video 1 [available at http://www.annemergmed.com]). DiagnosisBubble saline solution test for catheter placement confirmation.1Duran-Gehring P.E. Guirgis F.W. McKee K.C. et al.The bubble study: ultrasound confirmation of central venous catheter placement.Am J Emerg Med. 2015; 33: 315-319Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar During mechanical cardiopulmonary resuscitation in this patient, it took 3 seconds for the medication to reach the right heart chambers from the proximal humeral intraosseous site, similar to the 2.4-second duration observed in human volunteers.2Montez D.F. Puga T. Miller L. et al.133 intraosseous infusions from the proximal humerus reach the heart in less than 3 seconds in human volunteers.Ann Emerg Med. 2015; 66: S47Abstract Full Text Full Text PDF Google Scholar In out-of-hospital cardiac arrest, intraosseous access may allow rapid administration of medications1Duran-Gehring P.E. Guirgis F.W. McKee K.C. et al.The bubble study: ultrasound confirmation of central venous catheter placement.Am J Emerg Med. 2015; 33: 315-319Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar, 2Montez D.F. Puga T. Miller L. et al.133 intraosseous infusions from the proximal humerus reach the heart in less than 3 seconds in human volunteers.Ann Emerg Med. 2015; 66: S47Abstract Full Text Full Text PDF Google Scholar, 3Tan B.K.K. Chin Y.X. Koh Z.X. et al.Clinical evaluation of intravenous alone versus intravenous or intraosseous access for treatment of out-of-hospital cardiac arrest.Resuscitation. 2021; 159: 129-136Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar, 4Kawano T. Grunau B. Scheuermeyer F.X. et al.Intraosseous vascular access is associated with lower survival and neurologic recovery among patients with out-of-hospital cardiac arrest.Ann Emerg Med. 2018; 71: 588-596Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar, 5Daya M.R. Leroux B.G. Dorian P. et al.Survival after intravenous versus intraosseous amiodarone, lidocaine, or placebo in out-of-hospital shock-refractory cardiac arrest.Circulation. 2020; 141: 188-198Crossref PubMed Scopus (25) Google Scholar; however, retrospective analyses have reported inferior survival compared to intravenous access.3Tan B.K.K. Chin Y.X. Koh Z.X. et al.Clinical evaluation of intravenous alone versus intravenous or intraosseous access for treatment of out-of-hospital cardiac arrest.Resuscitation. 2021; 159: 129-136Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar, 4Kawano T. Grunau B. Scheuermeyer F.X. et al.Intraosseous vascular access is associated with lower survival and neurologic recovery among patients with out-of-hospital cardiac arrest.Ann Emerg Med. 2018; 71: 588-596Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar, 5Daya M.R. Leroux B.G. Dorian P. et al.Survival after intravenous versus intraosseous amiodarone, lidocaine, or placebo in out-of-hospital shock-refractory cardiac arrest.Circulation. 2020; 141: 188-198Crossref PubMed Scopus (25) Google Scholar Bubble saline solution test for catheter placement confirmation.1Duran-Gehring P.E. Guirgis F.W. McKee K.C. et al.The bubble study: ultrasound confirmation of central venous catheter placement.Am J Emerg Med. 2015; 33: 315-319Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar During mechanical cardiopulmonary resuscitation in this patient, it took 3 seconds for the medication to reach the right heart chambers from the proximal humeral intraosseous site, similar to the 2.4-second duration observed in human volunteers.2Montez D.F. Puga T. Miller L. et al.133 intraosseous infusions from the proximal humerus reach the heart in less than 3 seconds in human volunteers.Ann Emerg Med. 2015; 66: S47Abstract Full Text Full Text PDF Google Scholar In out-of-hospital cardiac arrest, intraosseous access may allow rapid administration of medications1Duran-Gehring P.E. Guirgis F.W. McKee K.C. et al.The bubble study: ultrasound confirmation of central venous catheter placement.Am J Emerg Med. 2015; 33: 315-319Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar, 2Montez D.F. Puga T. Miller L. et al.133 intraosseous infusions from the proximal humerus reach the heart in less than 3 seconds in human volunteers.Ann Emerg Med. 2015; 66: S47Abstract Full Text Full Text PDF Google Scholar, 3Tan B.K.K. Chin Y.X. Koh Z.X. et al.Clinical evaluation of intravenous alone versus intravenous or intraosseous access for treatment of out-of-hospital cardiac arrest.Resuscitation. 2021; 159: 129-136Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar, 4Kawano T. Grunau B. Scheuermeyer F.X. et al.Intraosseous vascular access is associated with lower survival and neurologic recovery among patients with out-of-hospital cardiac arrest.Ann Emerg Med. 2018; 71: 588-596Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar, 5Daya M.R. Leroux B.G. Dorian P. et al.Survival after intravenous versus intraosseous amiodarone, lidocaine, or placebo in out-of-hospital shock-refractory cardiac arrest.Circulation. 2020; 141: 188-198Crossref PubMed Scopus (25) Google Scholar; however, retrospective analyses have reported inferior survival compared to intravenous access.3Tan B.K.K. Chin Y.X. Koh Z.X. et al.Clinical evaluation of intravenous alone versus intravenous or intraosseous access for treatment of out-of-hospital cardiac arrest.Resuscitation. 2021; 159: 129-136Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar, 4Kawano T. Grunau B. Scheuermeyer F.X. et al.Intraosseous vascular access is associated with lower survival and neurologic recovery among patients with out-of-hospital cardiac arrest.Ann Emerg Med. 2018; 71: 588-596Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar, 5Daya M.R. Leroux B.G. Dorian P. et al.Survival after intravenous versus intraosseous amiodarone, lidocaine, or placebo in out-of-hospital shock-refractory cardiac arrest.Circulation. 2020; 141: 188-198Crossref PubMed Scopus (25) Google Scholar Supplementary DataeyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiJjNWU1ZmRjZGI1MDQ1ZTc4NDU5M2E5NzAwNGE3NDQ0YSIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjcwMTgzNzkxfQ.svgCsRFUl0CSUR6qSMg20j1kkawY2ddloka5KbATKq9tcK3nKn0FnMWBZIbrj0O1E0-oJxx-_XWTFRgGHO5-9GmdRpBskG6bQAZ6Q0gvF9hDpgpgdMotFZaQEEtGwTtyYUu9xgYBXAMhlGZTW5n4RxVF07D8kjyNP_pNgrkj5kuBl92gslw_U7tXSH4kN56dErxD3iemyyV5PHlIc1Z5n79XOHH74-sd_1uFxH_Udx2-me1U_NM7F8qOGesQ_RTUlXQJwjzg5XsCl_OqVk9Uhzu_8491z5jNG1U37R4XjwIoRbDo28mcjmYdKVfTmZahAqyfZjln3gfxBbqI2qxsog Download .mp4 (8.98 MB) Help with .mp4 files Video 1 eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiJjNWU1ZmRjZGI1MDQ1ZTc4NDU5M2E5NzAwNGE3NDQ0YSIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjcwMTgzNzkxfQ.svgCsRFUl0CSUR6qSMg20j1kkawY2ddloka5KbATKq9tcK3nKn0FnMWBZIbrj0O1E0-oJxx-_XWTFRgGHO5-9GmdRpBskG6bQAZ6Q0gvF9hDpgpgdMotFZaQEEtGwTtyYUu9xgYBXAMhlGZTW5n4RxVF07D8kjyNP_pNgrkj5kuBl92gslw_U7tXSH4kN56dErxD3iemyyV5PHlIc1Z5n79XOHH74-sd_1uFxH_Udx2-me1U_NM7F8qOGesQ_RTUlXQJwjzg5XsCl_OqVk9Uhzu_8491z5jNG1U37R4XjwIoRbDo28mcjmYdKVfTmZahAqyfZjln3gfxBbqI2qxsog Download .mp4 (8.98 MB) Help with .mp4 files Video 1