Intraosseous Insertions during Out-of-Hospital Cardiac Arrest–Arm or Leg?

According to a recent observational study by Rosalyn Reades, MD, et al, tibial intraosseous insertion (IO) needle placement appeared to be a more effective insertion site than the proximal humerus.1 The study found that success rates were higher for this location and the incidence of needle dislodgements was lower.


The study included medical cardiac arrest patients for whom resuscitative efforts were performed. Cardiac arrest protocols stipulate that paramedics insert an IO line for initial vascular access. During the first month of the study, the humerus was the primary insertion site, while the tibia was the preferred site during the second month of the study.


The authors recommend that further randomized studies be conducted in order to validate the results.


  1. Reades R, Studnek JR, Garrett JS, et al. Comparison of first-attempt success between tibial and humeral intraosseous insertions during out-of-hospital cardiac arrest. Prehosp Emerg Care. 2011; 15(2):278—281. doi:10.3109/10903127.2010.545479

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