In children requiring emergency vascular access, are intraosseous lines associated with significant long-term...

Intraosseous (IO) access is a technique increasingly used within trauma and emergency settings where immediate vascular access is required. It provides an effective alternative to intravenous access, particularly in paediatric patients where intravenous access is difficult, or where previous attempts have been unsuccessful. However, concerns remain regarding potential complications associated with IO use, including potential long-term adverse outcomes.A short cut review of the literature was carried out to determine long-term outcomes of IO access in paediatric patients requiring emergency vascular access. A total of 282 unique papers were found, of which 11 observational studies (three prospective, eight retrospective) included data on patients relevant to the clinical question; these are discussed in the paper. Across these studies, severe long-term complications following paediatric IO access were rare. Only one study reported a single case of osteomyelitis following IO access. No evidence of growth disturbance, venous thrombosis or fat embolism was identified, while isolated cases of compartment syndrome, fracture and extravasation were reported at low frequency. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the best papers are tabulated.The clinical bottom line is that severe complications are rarely reported with paediatric IO lines. Emergency clinicians should not be deterred from inserting or retaining IO lines when definitive intravenous access has yet to be established.