From the Guidelines
The EZ-IO device is not recommended for creating emergency burr holes in the skull. While the EZ-IO is an excellent tool for establishing intraosseous vascular access in emergency situations, as discussed in the guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures 1, it is not designed, validated, or approved for cranial drilling or creating burr holes to relieve intracranial pressure. The guidelines highlight the importance of being familiar with adjuncts to airway management and resuscitation, including the intraosseous needle, which can be life-saving in rare situations when rapid establishment of intravenous access is not possible 1. However, this does not extend to its use in neurosurgical procedures. Emergency burr holes should only be performed by neurosurgeons or properly trained physicians using appropriate neurosurgical equipment such as a cranial perforator or Hudson brace. Using an EZ-IO for this purpose could cause significant harm including:
- Excessive penetration into brain tissue
- Inadequate decompression
- Infection
- Hemorrhage
- Further neurological damage In a true emergency with suspected elevated intracranial pressure, the patient should be rapidly transported to a facility with neurosurgical capabilities while maintaining airway, breathing, and circulation, and implementing other measures to reduce intracranial pressure such as:
- Head elevation
- Mild hyperventilation
- Osmotic agents like mannitol or hypertonic saline when indicated The risks of an improvised burr hole with an inappropriate device far outweigh any potential benefits in almost all circumstances.