本邦における医師・救急救命士・看護師の骨髄内輸液路確保手技の比較(Comparison of intraosseous routes insertion between doctors, EMTs, and nurses in Japan: training course using chicken bones): 鶏肉を用いたトレーニングコースより

【目的】骨髄内輸液路（以下，骨髄路）確保は，小児の心停止や重症患者に対して有用であるが，本邦で施行可能な職種は医師のみである。医師，救急救命士（以下，救命士），看護師の職種ごとの骨髄路確保成功率と手技時間を比較検討した。【方法】用手で行う骨髄針（以下，MAN–IO）と，電動式骨髄穿刺キット（以下，EZ–IO）を用いて，各挿入方法ビデオを閲覧後，鶏肉の大腿骨に挿入した。外傷コース受講生291名の全手技をビデオで撮影し，成功率，施行時間を測定した。【結果】248名が解析対象となった。成功率は職種間で有意差を認めなかった（MAN–IO 1回目：医師60.9% vs. 救命士68.1% vs. 看護師61.1%，p=0.53；EZ–IO 1回目：医師80.4% vs. 救命士78.7% vs. 看護師75.9%，p=0.80）。成功時の穿刺時間も職種間で有意差を認めなかった（MAN–IO：医師12.5s vs. 救命士11.5s vs. 看護師13.4s，p=0.49；EZ–IO：医師5.34s vs. 救命士5.25s vs. 看護師4.84s，p=0.58）。【結語】救命士や看護師も，医師と同等に骨髄路確保ができることが示された。本邦の救命士の輸液路確保手技として，骨髄路確保は有用と考えられる。 Purpose : The intraosseous (IO) route is useful in cardiopulmonary arrest and critical illnesses in children but IO routes can only be inserted by doctors in Japan. We compared success rates and procedure times for insertion between different healthcare professionals: doctors, EMTs, and nurses. Method : The study employed the manual intraosseous infusion system (MAN–IO) and the semi–automatic intraosseous infusion system (EZ–IO). After the participants watched the standard video on how to use MAN–IO and EZ–IO, they tried to insert both MAN–IO and EZ–IO into the lower leg of a chicken. All attempts by the 291 participants in the trauma training course were recorded on video and success rates and procedure times were measured. Results : 248 participants were eligible for analysis. There was no significant difference in success rates between the different kinds of healthcare professionals (first attempt with MAN–IO: doctors 60.9%, EMTs 68.1%, nurses 61.1%, p=0.53; first attempt with EZ–IO: doctors 80.4%, EMTs 78.7%, nurses 75.9%, p=0.80). There was no significant difference in successful insertion time between the different healthcare professionals either (successful attempt with MAN–IO: doctors 12.5s, EMTs 11.5s, nurses 13.4s, p=0.49; successful attempt with EZ–IO: doctors 5.34s, EMTs 5.25s, nurses 4.84s, p=0.58). Conclusion : EMTs and nurses had the same success rates as doctors when inserting IO routes. IO routes are useful as venous routes established by EMTs in Japan.