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Pediatric intraosseous infusions: impact on vascular access time
P W Glaeser1, J D Losek, D B Nelson
1Department of Pediatrics, Medical College, Children's Hospital, Wisconsin, Milwaukee 53233.
Insights
Intraosseous infusions (IO) significantly reduced time to vascular access in pediatric cardiac arrest patients, especially those under 2. Early IO use is recommended for critical pediatric resuscitation.
Area of Science:
- Emergency Medicine
- Pediatric Critical Care
- Resuscitation Science
Background:
- Establishing vascular access is critical for pediatric resuscitation.
- Traditional intravenous access can be challenging and time-consuming in emergencies.
- Intraosseous (IO) infusion offers an alternative route for fluid and medication delivery.
Purpose of the Study:
- To evaluate the impact of intraosseous infusions on the time to establish vascular access in pediatric patients requiring immediate resuscitation.
- To compare the effectiveness of IO access in patients with and without cardiopulmonary arrest.
- To assess the safety and efficacy of early IO use in pediatric critical care.
Main Methods:
- Retrospective chart review of 81 pediatric patients requiring immediate vascular access for resuscitation.
- Categorization of patients into cardiopulmonary arrest (29) and non-cardiopulmonary arrest (52) groups.
- Comparison of time to vascular access between IO and standard techniques, with subgroup analysis for age.
Main Results:
- Intraosseous infusions significantly reduced the time to vascular access in the pediatric cardiac arrest group, particularly in children under 2 years old.
- The IO method was less effective in the non-arrest group, showing a significantly longer mean time to access.
- No significant complications were associated with the IO procedure; 50% of patients showed evidence of systemic absorption.
Conclusions:
- Intraosseous infusion is an effective method for rapidly establishing vascular access in pediatric patients experiencing cardiac arrest.
- Early consideration of IO infusion is recommended for both arrested and critical non-arrested pediatric patients needing immediate vascular access.
- IO access is a safe and valuable tool in pediatric emergency resuscitation, especially when conventional methods fail.
Abstract:
A 1-year retrospective chart review was performed to evaluate the effect of intraosseous infusions (IO) on the time required to establish vascular access in pediatric patients requiring immediate vascular access for resuscitation. Eighty-one patients were identified, including 29 pulseless and non-breathing and 52 noncardiopulmonary arrest children, who required intravenous fluids or medication for resuscitation. Comparing the results with a previous review, the IO method effectively reduced the time needed to establish vascular access in the arrested group when standard techniques failed, particularly in the child less than 2 years old. The IO method was not used effectively in the non-arrest group, as evidenced by a significantly greater mean time required to establish vascular access. There were no significant complications related to the IO procedure. Nine (50%) of the patients receiving IO fluids or medication had clinical and/or laboratory evidence that these substances reached the central circulation. Early use of IO infusion in the resuscitation is recommended for not only the arrested patient, but also the critical nonarrested patient requiring immediate vascular access.