REBEL Core Cast 140.0: The Power and Limitations of Intraosseous Lines in Emergency Medicine

Intraosseous (IO) lines provide rapid, reliable vascular access during critical resuscitations, particularly in cases of cardiac arrest and hemorrhagic shock. When traditional intravenous access fails in pediatric patients, the "one, two, IO" approach ensures timely intervention. While the proximal tibia remains the most common site due to its accessibility, the proximal humerus and sternum offer superior flow rates, with specialized sternal devices facilitating up to 500 cc of volume over five minutes. Despite their utility, IO lines have inherent limitations, including inaccurate laboratory sampling, single-lumen constraints, and a high risk of dislodgement. Consequently, these devices serve as a bridge for acute resuscitation; once a patient achieves stability, clinicians should transition to more secure, long-term access methods like central venous lines or peripheral intravenous catheters to ensure ongoing, reliable medication delivery.