Humoral EZ/IO and Lucas Devices


Forum Asst. Chief
If your #1 option is tibial IO, please be aware that on adult patients, it is not a good option for multiple reasons: it is the most distal site from the heart, if you infuse epinephrine, the drug will most probably get metabolized before it reaches the heart (half life of epi is around 100 sec and it can take up to 120 secs for the drug to reach the heart of an adult - this is why you will not that most of the studies made to demonstrate the equivalency of tibial IO to IV were made on animals with short legs, like i.e. goats), but more importantly, tibial IO will drastically increase the risk of pulmonary embolism in your adult patient, since it is a bone with fat marrow).

This is what the manufacturers of tibial IO needles don’t want you to know… They just want you to spend $120 on that IO needle…

Sternal IO is the best site (and it does not interfere with your CPR - anybody doing CPR on the sternum should consider a career change…), this is why it was adopted by the military as their #1 site, then comes humeral IO.
The epinephrine doesn't get metabolized during its venous return to the heart nor is the risk of fat emboli significantly higher in tibial than humeral.


Californian, Lost in Texas
I should probably point out that one of the greatest motivators for military adoption of the sternal IO is readily-identifiable anatomical markers in service members and the relative guarantee that the tissue and bone under a plate carrier/IOTV will remain intact even if limbs (and associated IO sites) are destroyed. In the fatter, less-traumatized civilian population, the EZ-IO is way more useful.

I mean, have you thought about the consequences of the Fast-1 anchor needles on thin, geriatric skin? Or the “harpooning a walrus” effect on someone with a lot of fatty tissue? It’s just not a great device for civilian EMS.