Page 36 - JSOM Winter 2025

A Prospective Comparison of SAM IO versus EZ-IO

Insertion Time and Usability During Simulated Vascular Access

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1
Rachel Stiglitz, BS, AEMT ; Roberto C. Portela, MD *;
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Stephen E. Taylor, PhD ; Juan A. March, MD 4

ABSTRACT
Background: Intraosseous (IO) access is a medical procedure out-of-hospital access points being the proximal tibia and hu-
primarily used in emergencies when peripheral venous access meral head for adult patients. 8–10
is unobtainable or delayed. The IO procedure is commonly
performed using the EZ-IO, a battery-powered intraosseous Teleflex’s Arrow EZ-IO Intraosseous Vascular Access System
™
driver. In contrast, the newer SAM IO is a less costly and (Figure 1) has been used in the out-of-hospital setting for the
manually powered driver. Our objective was to compare the last 20 years. 2,3,9–12 The EZ-IO is a semi-automatic IO device
EZ-IO and SAM IO by examining insertion times and EMS with a battery-powered driver that can be used in children and
clinicians’ preferences. Methods: This randomized prospective adults at multiple insertion sites, including the distal femur,
trial was performed with EMS clinicians after watching in- proximal tibia, distal tibia, and proximal humerus. This driver
structional videos. Participants practiced insertions with both is not rechargeable and has a set battery lifespan when it be-
drivers on plastic task trainers and porcine bones until they comes inoperable. In contrast, the SAM IO by SAM Med-
®
self-reported proficiency. Participants were randomized to one ical (Figure 1) is a manually actuated IO access system. The
of the drivers, and insertion times into a porcine humeral bone catheter placement is achieved by continuously squeezing the
were analyzed. All participants completed a post-study survey. driver’s trigger assembly while gently guiding the IO needle
Results: Study participants (n=106) using the EZ-IO had faster into position.
insertion times, mean 1.1 seconds (s) (95% CI 0.8–1.4), versus
the SAM IO, mean 2.8s (95% CI 2.5–3.1), P<.001. The mean FIGURE 1 Arrow EZ-IO and SAM IO drivers and needles.
difference was less than 2s and unlikely to be clinically signif-
icant. All attempts were deemed successful. Most considered
the SAM IO easy to use 68.6% (74/106), and 80.0% (85/106)
reported confidence in patient use. Despite this, participants
expressed some reservations. Conclusions: In the largest ran-
domized controlled trial to date, we found that the EZ-IO had
a faster insertion time compared to the SAM IO, but the time
difference was unlikely to be clinically meaningful. Although
participant responses indicated a preference for the EZ-IO,
most felt confident using the SAM IO in an EMS setting.

Keywords: EZ-IO; SAM IO; intraosseous; prehospital;
emergency medical service; emergency vascular access;
porcine bone model
Both IO needle set devices consist of a stainless steel catheter
surrounding a stylet. Once inserted into the bone marrow
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Introduction
space, the stylet is removed. Fluids and medications can be
Intraosseous (IO) access is a medical procedure commonly administered through the hollow needle into the bone marrow.
used in emergencies where peripheral or central venous ac- The EZ-IO requires twisting the stylet off the hollow needle
cess cannot be obtained in a timely manner. 1–3 In the out-of- assembly, while the SAM IO requires only a pulling motion on
hospital setting, IO needle insertion is commonly used during the snap-fit needle assembly.
cardiac arrests and other emergency etiologies. Emergency
4–8
Medical Services (EMS) clinicians insert a metal cannula The objective of this study was to compare needle insertion
through the skin into the medullary space in the bone either times between the battery-powered EZ-IO driver currently
manually or with the assistance of a driver. This space acts as used and the newer, manually actuated SAM IO driver in a
a non- collapsible cavity and allows rapid delivery of medica- porcine humeral bone model, then obtain feedback from
tions. Multiple locations can be used, with the most common out-of-hospital personnel on both devices.
*Correspondence to portelar@ecu.edu
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1 Rachel Stiglitz, Dr. Roberto C. Portela, Dr. Stephen E. Taylor, and Dr. Juan A. March are affiliated with the Division of EMS, Department of
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Emergency Medicine, East Carolina University, Greenville, NC.
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