Background: For anaphylaxis, a life-threatening allergic reaction, the incidence rate was presented to have increased from the beginning of the 21st century. Underdiagnosis and undertreatment of anaphylaxis are public health concerns. Objective: This guideline aimed to provide high-quality and evidence-based recommendations for the emergency management of anaphylaxis. Method: The panel of health professionals from fifteen medical areas selected twenty-five clinical questions and formulated the recommendations with the supervision of four methodologists. We collected evidence by conducting systematic literature retrieval and using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Results: This guideline made twenty-five recommendations that covered the diagnosis, preparation, emergency treatment, and post-emergency management of anaphylaxis. We recommended the use of a set of adapted diagnostic criteria from the American National Institute of Allergy and Infectious Diseases and the Food Allergy and Anaphylaxis Network (NIAID/FAAN), and developed a severity grading system that classified anaphylaxis into four grades. We recommended epinephrine as the first-line treatment, with specific doses and routes of administration for different severity of anaphylaxis or different conditions. Proper dosage is critical in the administration of epinephrine, and the monitor is important in the IV administration. Though there was only very low or low-quality evidence supported the use of glucocorticoids and H1 antagonists, we still weakly recommended them as second-line medications. We could not make a well-directed recommendation regarding premedication for preventing anaphylaxis since it is difficult to weigh the concerns and potential effects. Conclusion: For the emergency management of anaphylaxis we conclude that: • NIAID/FAAN diagnostic criteria and the four-tier grading system should be used for the diagnosis • Prompt and proper administration of epinephrine is critical.

Objective: This study aimed to investigate the predictive value of pulse oximetry plethysmography (POP) for the return of spontaneous circulation (ROSC) in cardiac arrest (CA) patients. Methods: This was a multicenter, observational, prospective cohort study of patients hospitalized with cardiac arrest at 14 teaching hospitals cross China from December 2013 through November 2014. The study endpoint was ROSC, defined as the restoration of a palpable pulse and an autonomous cardiac rhythm lasting for at least 20 minutes after the completion or cessation of CPR. Results: 150 out-of-hospital cardiac arrest (OHCA) patients and 291 in-hospital cardiac arrest (IHCA) patients were enrolled prospectively. ROSC was achieved in 20 (13.3%) and 64 (22.0%) patients in these cohorts, respectively. In patients with complete end-tidal carbon dioxide (ETCO2) and POP data, patients with ROSC had significantly higher levels of POP area under the curve (AUCp), wave amplitude (Amp) and ETCO2 level during CPR than those without ROSC (all p < 0.05). Pairwise comparison of receiver operating characteristic (ROC) curve analysis indicated no significant dierence was observed between ETCO2 and Amp (p = 0.204) or AUCp (p = 0.588) during the first two minutes of resuscitation. Conclusion: POP may be a novel and eective method for predicting ROSC during resuscitation, with a prognostic value similar to ETCO2 at early stage.

目标温度管理是心脏骤停复苏后昏迷患者的重要治疗手段,能够减轻神经系统损伤,改善神经功能预后.我国心脏骤停后的目标温度管理起步较晚,临床医师对其认识不充分,尚未形成规范化的治疗方案.北京大学第三医院急诊科是国内率先开展目标温度管理的单位之一,制定了标准化的实施规范和针对常见并发症的应对策略.本实施规范是本单位多年来的临床经验,分享规范旨在为同行开展目标温度管理提供借鉴.

通过回顾性分析2021年国际雪联系列测试活动(以下简称"相约北京")医疗保障工作,解决院前急救与院内急救缺乏实时衔接和协同救治的问题.依托5G+物联网技术,应用智慧医疗、移动医疗,以崇礼院区指挥中心为基础,建设院前院内紧密衔接的冬奥会医疗保障指挥调度平台.通过指挥调度平台实现竞赛以及与竞赛直接相关延伸区域的场地(field of play,FOP)、固定医疗站、救护车转运途中与崇礼院区指挥中心音视频实时互联互通、生命体征和医学影像的传输,院内专家指导院前医生实施救治工作.指挥调度平台可为伤员从受伤时刻起到救治结束的全过程获得高质量、高效率的救治,提升冬奥会医疗保障水平,在后奥运时代发展前景良好.

Abstract. Background:. Acute heart failure (AHF) is the most common disease in emergency departments (EDs). However, clinical data exploring the outcomes of patients presenting AHF in EDs are limited, especially the long-term outcomes. The purposes of this study were to describe the long-term outcomes of patients with AHF in the EDs and further analyze their prognostic factors. Methods:. This prospective, multicenter, cohort study consecutively enrolled 3335 patients with AHF who were admitted to EDs of 14 hospitals from Beijing between January 1, 2011 and September 23, 2012. Kaplan-Meier and Cox regression analysis were adopted to evaluate 5-year outcomes and associated predictors. Results:. The 5-year mortality and cardiovascular death rates were 55.4% and 49.6%, respectively. The median overall survival was 34 months. Independent predictors of 5-year mortality were patient age (hazard ratio [HR]: 1.027, 95 confidence interval [CI]: 1.023–1.030), body mass index (BMI) (HR: 0.971, 95% CI: 0.958–0.983), fatigue (HR: 1.127, 95% CI: 1.009–1.258), ascites (HR: 1.190, 95% CI: 1.057–1.340), hepatic jugular reflux (HR: 1.339, 95% CI: 1.140–1.572), New York Heart Association (NYHA) class III to IV (HR: 1.511, 95% CI: 1.291–1.769), heart rate (HR: 1.003, 95% CI: 1.001–1.005), diastolic blood pressure (DBP) (HR: 0.996, 95% CI: 0.993–0.999), blood urea nitrogen (BUN) (HR: 1.014, 95% CI: 1.008–1.020), B-type natriuretic peptide (BNP)/N-terminal pro-B-type natriuretic peptide (NT-proBNP) level in the third (HR: 1.426, 95% CI: 1.220–1.668) or fourth quartile (HR: 1.437, 95% CI: 1.223–1.690), serum sodium (HR: 0.980, 95% CI: 0.972–0.988), serum albumin (HR: 0.981, 95% CI: 0.971–0.992), ischemic heart diseases (HR: 1.195, 95% CI: 1.073–1.331), primary cardiomyopathy (HR: 1.382, 95% CI: 1.183–1.614), diabetes (HR: 1.118, 95% CI: 1.010–1.237), stroke (HR: 1.252, 95% CI: 1.121–1.397), and the use of diuretics (HR: 0.714, 95% CI: 0.626–0.814), β-blockers (HR: 0.673, 95% CI: 0.588–0.769), angiotensin-converting enzyme inhibitors (ACEIs) (HR: 0.714, 95% CI: 0.604–0.845), angiotensin-II receptor blockers (ARBs) (HR: 0.790, 95% CI: 0.646–0.965), spironolactone (HR: 0.814, 95% CI: 0.663–0.999), calcium antagonists (HR: 0.624, 95% CI: 0.531–0.733), nitrates (HR: 0.715, 95% CI: 0.631–0.811), and digoxin (HR: 0.579, 95% CI: 0.465–0.721). Conclusions:. The results of our study demonstrate poor 5-year outcomes of patients presenting to EDs with AHF. Age, BMI, fatigue, ascites, hepatic jugular reflux, NYHA class III to IV, heart rate, DBP, BUN, BNP/NT-proBNP level in the third or fourth quartile, serum sodium, serum albumin, ischemic heart diseases, primary cardiomyopathy, diabetes, stroke, and the use of diuretics, β-blockers, ACEIs, ARBs, spironolactone, calcium antagonists, nitrates, and digoxin were independently associated with 5-year all-cause mortality.

BACKGROUND: It is challenging to establish peripheral intravenous access in adult critically patients. This study aims to compare the success rate of the first attempt, procedure time, operator satisfaction with the used devices, pain score, and complications between intraosseous (IO) access and central venous catheterization (CVC) in critically ill Chinese patients. METHODS: In this prospective clustered randomized controlled trial, eight hospitals were randomly divided into either the IO group or the CVC group. Patients who needed emergency vascular access were included. From April 1, 2017 to December 31, 2018, each center included 12 patients. We recorded the data mentioned above. RESULTS: A total of 96 patients were enrolled in the study. There were no statistically significant differences between the two groups regarding sex, age, body mass index, or operator satisfaction with the used devices. The success rates of the first attempt and the procedure time were statistically significant between the IO group and the CVC group (91.7% vs. 50.0%, P<0.001; 52.0 seconds vs. 900.0 seconds, P<0.001). During the study, 32 patients were conscious. There was no statistically significant difference between the two groups regarding the pain score associated with insertion. There were statistically significant differences between the two groups regarding the pain score associated with IO or CVC infusion (1.5 vs. 0.0, P=0.044). Complications were not observed in the two groups. CONCLUSIONS: IO access is a safe, rapid, and effective technique for gaining vascular access in critically ill adults with inaccessible peripheral veins in the emergency departments.

This study aimed to investigate the predictive value of pulse oximetry plethysmography (POP) for the return of spontaneous circulation (ROSC) in cardiac arrest (CA) patients.This was a multicenter, observational, prospective cohort study of patients hospitalized with cardiac arrest at 14 teaching hospitals cross China from December 2013 through November 2014. The study endpoint was ROSC, defined as the restoration of a palpable pulse and an autonomous cardiac rhythm lasting for at least 20 minutes after the completion or cessation of CPR.150 out-of-hospital cardiac arrest (OHCA) patients and 291 in-hospital cardiac arrest (IHCA) patients were enrolled prospectively. ROSC was achieved in 20 (13.3%) and 64 (22.0%) patients in these cohorts, respectively. In patients with complete end-tidal carbon dioxide (ETCO2) and POP data, patients with ROSC had significantly higher levels of POP area under the curve (AUCp), wave amplitude (Amp) and ETCO2 level during CPR than those without ROSC (all p < 0.05). Pairwise comparison of receiver operating characteristic (ROC) curve analysis indicated no significant difference was observed between ETCO2 and Amp (p = 0.204) or AUCp (p = 0.588) during the first two minutes of resuscitation.POP may be a novel and effective method for predicting ROSC during resuscitation, with a prognostic value similar to ETCO2 at early stage.

Objective:To investigate the clinical characteristics and predictors of outcomein patients with bloodstream infection (BSI) in emergency department(ED).Methods:This was a retrospective cohort study on patients with BSI in ED of a tertiary hospital in Beijing in 2018. A total of 141 patients were divided into two groups, based on patient outcome on hospital discharge. Data were collected from electronic medical records including demographics of the patients and characteristics of the blood culture as well as treatment during hospital stay. Multivariable binary logistic regression was then performed to explore the predicting factors associated with unfavorable outcome.Results:The median age of patients was 69 years (IQR 61-81 years) with 88 males (62.4%). There were 115 (81.6%) patients received intensive care, and 47 (33.3%) had septic shock.Univariate analysis revealed that comorbidities, immunosuppression treatment, multi-site infection, central vein catheterization, shock and intensive care were associated with poor prognosis. The most common sources of BSI in ED patients were urinary tract (29.8%), hepatobiliary system (22%) and lower respiratory tract (21.3%); Escherichia coli, Klebsiella pneumoniae and Staphylococcus aureus were the most common strains. Multivariate binary logistic regression showed that the number of comorbidities, shock and drug-resistant bacteria infection were independent risk factors for unfavorable prognosis in patients with BSI, while the prognosis of BSI from urinary system was relatively good.Conclusions:ED physicians should optimize antibiotics according to the comorbidities, source of infection, severity of disease and risk of drug-resistant bacteria infection aiming to improve the prognosis of patients with BSI.

Whether the anemia increases the risk of mortality in patients with acute heart failure (AHF) remains unclear. This study aims to explore the relationship between anemia and outcomes in patients with AHF including subgroup analysis. This study included 3279 patients with hemoglobin available from the Beijing Acute Heart Failure Registry (Beijing AHF Registry) study. The primary endpoint was all-cause mortality in 1 year, and the secondary endpoint was 1-year all-cause events including all-cause death and readmission. Logistic regression models were applied to describe related variables of anemia in patients with AHF. Multivariate Cox proportional hazards models described associations of anemia with clinical outcomes in the overall cohort and subgroups. 45.4% of the patients were found anemic. They were older and had more comorbidities than non-anemic patients. Variables including older age, female, chronic kidney dysfunction (CKD), lower hematocrit, lower albumin, with loop diuretics applied, without beta-blockers, angiotensin-converting enzyme inhibitors /angiotensin receptor blockers (ACEIs/ARBs) and spironolactone applied in the emergency department (ED) were associated with anemia in AHF patients. Anemic patients had higher 1-year mortality (38.4% vs. 27.2%, p < 0.0001) and 1-year events rates (63.2% vs. 56.7%, p < 0.0001). After adjusted for covariates, anemia was associated with the increase of 1-year mortality (hazard ratio [HR] 1.278; 95% confidence interval [CI] 1.114–1.465; p = 0.0005) and 1-year events (HR 1.136; 95% CI 1.025–1.259; p = 0.0154). The severer anemia patients had higher risks both of 1-year mortality and events. In the subgroup analysis, the independent associations of anemia with 1-year mortality were shown in the subgroups including age < 75 years, male, body mass index < 25 kg/m2 and BMI ≥ 25 kg/m2, New York Heart Association (NYHA) functional class I–II and NYHA functional class III–IV, with and without cardiovascular ischemia, heart rate (HR) < 100 bpm and HR ≥ 100 bpm, systolic blood pressure (SBP) < 120 mmHg and SBP ≥ 120 mmHg, left ventricular ejection fraction (LVEF) < 40% and LVEF ≥ 40%, serum creatinine (Scr) < 133 umol/l, and with diuretics use, with and without beta-blockers use, without ACEIs/ARBs use in the ED. Anemia is associated with older age, female, CKD, volume overload, malnutrition, with loop diuretics, without beta-blockers, ACEIs/ARBs and spironolactone administration, and higher mortality and readmission in AHF. The risk associations are particular significantly obvious in younger, male, overweight, preserved LVEF, lower Scr, with diuretics and beta-blockers, without ACEIs/ARBs administration subgroups. Clinical trial No. ChiCTR-RIC-17014222

目的 分析北京某三甲医院急诊科社区发病的血流感染(community-onset bloodstream infection,CO-BSI)病原学和临床特征.方法 本研究为单中心回顾性队列研究,纳入北京某三甲医院急诊科2018年CO-BSI患者的临床资料和血培养结果,对病原体分布、临床特征和细菌耐药情况进行分析.结果 共纳入107例患者,培养出112株病原体,大肠埃希菌(34.8％)、肺炎克雷伯菌(28.6％)和金黄色葡萄球菌(10.7％)是急诊CO-BSI最常见的病原体.①革兰阳性(gram-positive,G+)菌BSI中存在慢性肾脏病(32.1％ vs.11.4％,P=0.026)的比例高于革兰阴性(gram-negative,G-)菌BSI.G+菌BSI患者28 d病死率(46.4％ vs.22.8％,P=0.018)和住院病死率(53.6％ vs.26.6％,P=0.009)均高于G-菌BSI.②大肠埃希菌约2/3来源于泌尿系统感染,肝胆系统感染不到1/3;肺炎克雷伯菌则来源于肝胆系统(40.6％)、下呼吸道(28.1％)和泌尿系统(25.0％)为主;金黄色葡萄球菌以下呼吸道(33.3％)和皮肤软组织(16.7％)来源多见.③分离菌株中多重耐药(multidrug resistant,MDR)菌比例为44.4％.三代头孢和喹诺酮类耐药的大肠埃希菌分别为30.8％和48.7％,三代头孢耐药的肺炎克雷伯菌为9.4％,耐甲氧西林的金黄色葡萄球菌为8.3％.肠杆菌对丁胺卡那霉素、碳青霉烯类、除头孢曲松外的三代头孢菌素、除氨苄西林/舒巴坦外的β内酰胺类/β内酰胺酶抑制剂及替加环素敏感率均在80％以上.葡萄球菌对万古霉素、利奈唑胺100％敏感.结论 急诊科CO-BSI的病原体以G-杆菌多见,但G+菌BSI病死率高.CO-BSI的病原体存在多重耐药现象,但对大多数临床常用的抗菌药物保持着较好的敏感性.

Objective To explore the influence of medical care reform on crowded emergency department in the tertiary hospital.Methods The 8 April 2017 was considered as turning point when Beijing began to implement medical care reform.The research subgroups consisted of pre-medical reform group,intra-medical reform group and post-medical reform group,according to the date 20 days before the medical reform,20 days after the medical reform and 21-40 days after the medical reform.During this period,The NEDOCS scores(The National Emergency Department Overcrowding Scale) were calculated at 10:00,14:00,18:00 in the Emergency Department of Peking University Third Hospital every day,the mean of which assessed the degree of crowding.The key indicators in the NEDOCS scoring formula were compared to find the reasons for the change of emergency crowding.All statistical analyses were performed using SPSS version 25.0.Continuous data presented as means ± standard deviation (normal distribution),analyzed by t-tests or median ± quartile(abnormal distribution),analyzed by Mann-Whitney U test.Results The NEDOCS scores in the intra-medical reform group were statistically higher than that in the pre-medical reform group (401.69 vs 339.68,P＜0.05).The NEDOCS scores in the post-medical reform group were higher than that in the pre-medical reform group,but the difference was not statistically significant (380.83 vs 339.68,P＞0.05).The number of ventilated patients (Rn) significantly increased after the reform (P＜0.05).Conclusions The degree of emergency department crowding in the tertiary hospital has increased after the Beijing medical care reform in 2017.The increase in the number of critically ill patients may be the reason for the increased overcrowding in the emergency department.

With the progresses of aggravation of social population aging degree and elevation of health awareness, the emergency medical resources are difficult to meet the increasing demand for emergency medical services of patients, leading to the increase of congestion in the Department of Emergency that has threatened the safety of the entire medical and health system. Among the patients, because the elderly patient diseases are characterized by coexistence of multiple diseases, the complexity of diagnosis and treatment, etc, they occupy a large number of emergency medical resources, resulting in the main important factor affecting the overcrowding in emergency department. Therefore, we have comprehensively analyzed the domestic and foreign researches related to the overcrowding in emergency departments, summarized the effect of elderly patients on the overcrowding and reviewed the corresponding mitigation measures, expecting to provide a reference for the study of emergency department overcrowding in China.

Objective To evaluate the impact of body mass index (BMI) on survival of a Chinese cohort of medical patients with sepsis. Design A single-centre prospective cohort study conducted from May 2015 to April 2017. Setting A tertiary care university hospital in China. Participants A total of 178 patients with sepsis admitted to the medical intensive care unit (ICU) were included. Main outcome measures The primary outcome was 90-day mortality while the secondary outcomes were in-hospital mortality, length of ICU stay and length of hospital stay. Results The median age (IQR) was 78 (66-84) years old, and 77.0% patients were older than 65 years. The 90-day mortality was 47.2%. The in-hospital mortality was 41.6%, and the length of ICU stay and hospital stay were 12 (5-22) and 15 (9-28) days, respectively. Cox proportional hazard regression analysis identified that Sequential Organ Failure Assessment score (HR=1.229, p<0.001), Acute Physiology and Chronic Health Evaluation II score (HR=1.050, p<0.001) and BMI (HR=0.940, p=0.029) were all independently associated with the 90-day mortality. Patients were divided into four groups based on BMI (underweight 33 (18.5%), normal 98 (55.1%), overweight 36 (20.2%) and obese 11 (6.2%)). The 90-day mortality (66.7%, 48.0%, 36.1% and 18.2%, p=0.015) and in-hospital mortality (60.6%, 41.8%, 30.6% and 18.2%, p=0.027) were statistically different among the four groups. Differences in survival among the four groups were demonstrated by Kaplan-Meier survival analysis (p=0.008), with the underweight patients showing a lower survival rate. Conclusions BMI was an independent factor associated with 90-day survival in a Chinese cohort of medical patients with sepsis, with patients having a lower BMI at a higher risk of death.

目的 探讨急诊危重患者死亡分布特征,指导急诊资源合理分布及应用.方法 收集2013-2017年北京大学第三医院急诊科危重患者的临床资料,分析所有死亡患者的年龄、性别构成及死亡时间,应用帕累托图分析死因的构成情况.结果 (1)老年患者(≥60岁)占总死亡人数81.0％,年龄差异具有统计学意义(P＜0.05).(2)帕累托图分析显示,危重症患者的直接死因以呼吸系统疾病、猝死和(或)心脏骤停、休克、神经系统疾病为主.(3)在呼吸系统疾病、心血管系统疾病、休克患者中老年患者较非老年患者明显增多,而在神经系统疾病、猝死和(或)心脏骤停、创伤死亡患者中结果则相反(P＜0.05).在猝死和(或)心脏骤停、创伤疾病死亡患者中男性比女性常见,而在呼吸系统疾病中结果则相反(P＜0.05).(4)50.8％的死亡病例发生在患者入院后24h以内,其中猝死和(或)心脏骤停患者发病到死亡的中位数时间最短(1h),其次是休克(24h).而因恶性肿瘤死亡的患者发病到死亡的中位数时间可长达5040 h.结论 急诊科死亡患者以老年人为主,呼吸、猝死和(或)心脏骤停、休克、神经系统疾病为常见死因,大部分患者死于就诊早期,因此,需根据实际情况合理分配急诊医疗资源.

RATIONALE:Hashimoto's encephalopathy (HE) is an autoimmune-mediated encephalopathy rarely seen in Graves' disease, with <20 cases reported previously, associated with elevated concentration of circulating serum anti-thyroid antibodies usually responsive to steroid therapy. PATIENT CONCERNS:We present a HE case (25-year-old male) with Graves' disease, complicated by fever and pancytopenia. The patient presented with fever, gait impairment, delirium, agitation and disorientation. DIAGNOSES:Thyroid-related antibodies were elevated and brain magnetic resonance imaging confirmed symmetrical white-matter lesion. There was no evidence of infection or other reasons to explain all of his clinical manifestations. Hashimoto's encephalopathy (HE) is an autoimmune encephalopathy with various manifestations and the characteristic of elevated anti-thyroid antibodies and has no relationship to thyroid function. INTERVENTIONS:The patient had nonspecific clinical manifestations and excellently respond to glucocorticoid therapy.The symptoms and the radiographic abnormalities disappeared after glucocorticoid therapy. OUTCOMES:We followed up with him for 5 years, in which there was no recurrence and his thyroid function continued to be normal. LESSONS:It is important to evaluate thyroid function and related antibodies in patients present with neuropsychological symptoms to avoid delay in diagnosis.

The recommendations of Guideline for Emergency Management of Anaphylaxis answered 15 clinical questions about diagnosis,preparation for treatment,treatment measures,and post-treatment management of anaphylaxis and a total of 26 recommendations were formed.In the recommendations,the quality of evidence was divided into 4 levels:high,moderate,low,and very low.And the strength of recommendation was divided into 2 levels:strong and weak.The strength of recommendations was mainly determined by weighing the advantages and disadvantages,instead of relying on the quality of evidence.Emergency management of anaphylaxis in clinical practice could be carried out with reference to the recommendations of this guideline.

Objective To investigate the predictive value of serum N-terminal pro brain natriuretic peptide NT-proBNP in left ventricular diastolic dysfunction(LVDD) in septic shock patients.Methods According to retrospective analysis of clinical data 96 patients with septic shock were divided into LVDD group and non-LVDD group.General clinical data,APACHE scores,NT-proBNP,Troponin I(TNI),creatinine,procalcitonin,D-dimer and lactic acid within the first 24 hours after admission were recorded,and multi-factors logistic regression analysis was conducted to find independent risk factors for left ventricular diastolic dysfunction in septic shock patients Receiver operating characteristic curve ROC was constructed to indicate the predictive value.Results There were no significant differences in general clinical data,procalcitonin,D-dimer and lactic acid between two groups.Compared with non-LVDD group the levels of NT-proBNP [lgNT-proBNP (3.66±0.38) vs.(3.03±0.59),P =0.000],TNI [lgTNI(-1.45±0.86)vs.(-2.36±0.82),P ＜ 0.01] and creatinine [(186.12±124.24)vs.(101.16±57.01),P ＜ 0.01] in LVDD group were significantly higher.It was shown by multi-factors logistic regression analysis that NT-proBNP (OR=8.731,95％CI;1.541-49.466,P=0.014) was an independent risk factor for left ventricular diastolic dysfunction in septic shock patients.The area under the curve AUC of NT-proBNP was 0.813 with the cut-off value of 1 725 pg/μL,sensibility =88.6％,specificity =62.1％.Conclusion NT-proBNP was avaluable indicator in predicting left ventricular diastolic dysfunction in septic shock patients.

Objective To compare the time consumed for the procedure done,satisfaction and safety of the establishment of intraosseous (IO) access and central intravenous line placement (CVL) in critically ill patients using a randomized controlled trial.Methods The patients were randomly divided into the IO access group versus CVL group according to the inclusion criteria.The IO access and CVL were established,respectively for medicine or fluid administration.The success rates at the first attempt,time required for procedure completed,satisfaction and complications were recorded.Results During the study period,24 patients were enrolled,and divided equally and randomly into IO group (n=12) and CVL group (n=12).There were no significant differences in age,gender,BMI between the two groups.The patients with shock and cardiac arrest accounted for 83.3 ％ in IO group and 58.3 ％ in CVL group,respectively.The success rates at the first attempt was 91.7 ％ in IO access group versus 66.7 ％ in CVL group (P=0.158).the time required for procedure done was significantly shorter in IO access group (74.9 ±43.7)s compared with CVL group (944.0 s±491.5 s) (P＜0.01).The satisfaction of operators at the instruments used was 8.0±1.1 for IO access group versus 7.2±0.8 for CVL group (P==0.053).The overall satisfaction of the operators at the entire course of procedure was 3.7 + 0.7 in IO access group versus 3.9±0.3 in CVL group (P=0.377).Complications were not observed during the study period in the two groups.Conclusions The success rate at the first attempt was significantly higher in IO access group compared with CVL grouThe mean time consumed for procedure completed in IO group was much shorter than that in CVL group,and the operation was simple and practicable.During the emergency care of critical patients,if the peripheral intravenous line placement was difficult to establish,and IO access could be a choice of alternative used as a bridging procedure to rapidly establish the vascular access and win the rescue opportunity.