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Use of Intraosseous Access in Neonatal and Pediatric Retrieval-Neonatal and Pediatric Emergency Transfer Service, New
Carsten Joerck, Robert Wilkinson, Rajeshwar Reddy Angiti1
1From the Newborn and Pediatric Emergency Transport Service (NETS NSW).
Insights
Intraosseous (IO) access is effective for critically ill neonates and children during retrieval, with survival rates higher than previously reported. Early IO insertion aids resuscitation and drug delivery, though it had no effect on ductus arteriosus in this study.
Area of Science:
- Emergency Medicine
- Pediatric Critical Care
- Neonatal Intensive Care
Background:
- Critically unwell pediatric and neonatal patients require rapid vascular access for life-saving interventions.
- The intraosseous (IO) route is a recognized method for central circulatory access.
- Limited data exists on IO use in neonatal and pediatric retrieval settings.
Purpose of the Study:
- To review the frequency, complications, and efficacy of intraosseous (IO) insertion in neonatal and pediatric patients undergoing retrieval.
- To assess the outcomes associated with IO use in this specific patient population.
Main Methods:
- Retrospective review of cases from a neonatal and pediatric emergency transfer service (2006-2020).
- Audit of medical records for patient demographics, diagnoses, treatments, IO insertion details, complications, and mortality.
- Analysis of data from 467 patients (102 neonatal, 365 pediatric).
Main Results:
- Intraosseous access was utilized in 467 patients, with common indications including sepsis, respiratory distress, cardiac arrest, and encephalopathy.
- Effective resuscitation outcomes observed: 52.9% return of spontaneous circulation, 73.1% improved perfusion with fluid bolus, 63.2% improved blood pressure with inotropes, and 88.7% seizure termination.
- Intraosseous access-related injury occurred in 10.8% of neonates and 14.2% of pediatric patients; overall mortality was 18.6% (neonatal) and 19.2% (pediatric).
Conclusions:
- Survival rates for retrieved neonatal and pediatric patients requiring intraosseous (IO) access are higher than previously reported in adult and pediatric cohorts.
- Early IO insertion facilitates prompt volume expansion and critical drug administration, providing crucial time for retrieval teams to establish definitive venous access.
- Prostaglandin E1 administered via distal limb IO demonstrated no efficacy in reopening the ductus arteriosus in this cohort.
Objectives:
Pediatric patients who are critically unwell require rapid access to central vasculature for administration of life-saving medications and fluids. The intraosseous (IO) route is a well-described method of accessing the central circulation. There is a paucity of data surrounding the use of IO in neonatal and pediatric retrieval. The aim of this study was to review the frequency, complications, and efficacy of IO insertion in neonatal and pediatric patients in retrieval.
Methods:
A retrospective review of cases referred to neonatal and pediatric emergency transfer service, New South Wales over the epoch 2006 to 2020. Medical records documenting IO use were audited for patient demographic data, diagnosis, treatment details, IO insertion and complication statistics, and mortality data.
Results:
Intraosseous access was used in 467 patients (102 neonatal/365 pediatric). The most common indications were sepsis, respiratory distress, cardiac arrest, and encephalopathy. The main treatments were fluid bolus, antibiotics, maintenance fluids, and resuscitation drugs. Return of spontaneous circulation after resuscitation drugs occurred in 52.9%; perfusion improved with fluid bolus in 73.1%; blood pressure improved with inotropes in 63.2%; seizures terminated with anticonvulsants in 88.7%. Prostaglandin E1 was given to eight patients without effect. Intraosseous access-related injury occurred in 14.2% of pediatric and 10.8% of neonatal patients. Neonatal and pediatric mortality rates were 18.6% and 19.2%, respectively.
Conclusions:
Survival in retrieved neonatal and pediatric patients who required IO is higher than previously described in pediatric and adult cohorts. Early insertion of an IO facilitates early volume expansion, delivery of critical drugs, and allows time for retrieval teams to gain more definitive venous access. In this study, prostaglandin E1 delivered via a distal limb IO had no success in reopening the ductus arteriosus.
