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Intravascular access in pediatric cardiac arrest
1Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN 55415.
Insights
For pediatric cardiac arrest patients, intraosseous infusion is a rapid and effective method for establishing intravascular access. This study highlights its success rates compared to other techniques in emergency department settings.
Area of Science:
- Pediatric Emergency Medicine
- Critical Care
- Vascular Access Techniques
Background:
- Pediatric cardiac arrest presents unique challenges for emergency care.
- Establishing timely intravascular access is crucial for resuscitation efforts in critically ill children.
Purpose of the Study:
- To retrospectively review methods of achieving intravascular access in pediatric patients experiencing cardiac arrest.
- To compare the success rates and speed of different vascular access techniques.
Main Methods:
- Retrospective review of 33 pediatric cardiac arrest cases (age < 48 months) from 1984-1986.
- Analysis of emergency department records, radiographs, hospital charts, and autopsy reports.
- Evaluation of success rates for central venous catheterization, surgical cutdown, intraosseous infusion, and peripheral catheterization.
Main Results:
- Intraosseous infusion (83%) and surgical vein cutdown (81%) demonstrated high success rates.
- Percutaneous peripheral catheterization had a low success rate (17%) but was fast when successful.
- Bone marrow needle placement was also a rapid method for access.
Conclusions:
- Intraosseous infusion is a highly successful and recommended method for pediatric intravascular access during cardiac arrest.
- Brief attempts at peripheral intravenous catheterization should be followed by rapid conversion to intraosseous infusion if unsuccessful.
Abstract:
All cases of patients aged less than 48 months who presented in cardiac arrest to the Hennepin County Medical Center's emergency department (ED) during the years 1984 to 1986 were reviewed retrospectively. The ED record, initial and subsequent chest radiographs, hospital charts, and autopsy reports were analyzed. A total of 33 cases were reviewed. The average patient age was 5 months. The average time needed to establish intravascular access was 7.9 +/- 4.2 minutes. Success rates were 77% for central venous catheterization, 81% for surgical vein cutdown, 83% for intraosseous infusion, and 17% for percutaneous peripheral catheterization. Percutaneous peripheral catheterization, when successful, and bone marrow needle placement were the fastest methods of obtaining intravascular access. There were no major immediate complications, and delayed complications were minimal. Attempts at peripheral intravenous catheter placement should be brief, with rapid progression to intraosseous infusion if peripheral attempts are not successful.