EMS Use and Success Rates of Intraosseous Infusion for Pediatric Resuscitations: A Large Regional Health System...

Area of Science:

• Emergency Medicine
• Pediatric Resuscitation
• Vascular Access

Background:

• Intraosseous (IO) access is a critical technique in emergency resuscitation, particularly for pediatric patients.
• Prehospital success rates for semi-automatic IO devices range from 70-100%, yet data on insertion time and functional duration are limited.
• Infants may experience less successful IO access in pediatric emergency departments.

Purpose of the Study:

• To explore the utilization and effectiveness of intraosseous (IO) access for pediatric resuscitation.
• To analyze time to insertion and duration of IO function in prehospital and pediatric emergency department (PED) settings.

Main Methods:

• Retrospective review of emergency medical services (EMS) patient care reports and PED data.
• Analysis of patients aged 0-17 years transported by regional ground EMS agencies from 2012-2019.
• Calculation of mean and median time to first insertion and IO function duration.

Main Results:

• Successful prehospital IO access was achieved in 83.7% of pediatric patients.
• Median time to IO access was 4 minutes, with a mean IO function duration of 27.6 minutes.
• Infants (<1 year) demonstrated significantly fewer functional IOs, more insertion attempts, and shorter IO function duration compared to older children (p < 0.05).

Conclusions:

• This study provides the first prehospital data on IO access time and duration in pediatric resuscitation.
• Evidence suggests inferior IO function in infants <1 year old in the prehospital setting.
• Unique challenges in infant IO access require consideration for pediatric emergency departments, interfacility transport, and critical care.