A Prospective Comparison of SAM IO versus EZ-IO: Insertion Time and Usability During Simulated Vascular Access.
Journal of special operations medicine · 2025-12-01 · Randomised trial
Abstract
OBJECTIVES: Intraosseous (IO) access is a medical procedure primarily used in emergencies when peripheral venous access is unobtainable or delayed. The IO procedure is commonly performed using the EZ-IO, a battery-powered intraosseous driver. In contrast, the newer SAM IO is a less costly and manually powered driver. Our objective was to compare the EZ-IO and SAM IO by examining insertion times and EMS clinicians' preferences. METHODS: This randomized prospective trial was performed with EMS clinicians after watching in-structional videos. Participants practiced insertions with both drivers on plastic task trainers and porcine bones until they self-reported proficiency. Participants were randomized to one of the drivers, and insertion times into a porcine humeral bone were analyzed. All participants completed a post-study survey. RESULTS: Study participants (n=106) using the EZ-IO had faster 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 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.