Paediatric resuscitation in adverse circumstances: a comparison of three routes of systemic access

Nine Kurdish children were admitted to a British Surgical Support Team facility in Northern Iraq, requiring resuscitation for dehydration estimated to be of 10% loss of body weight. Systemic access was by intravenous (IV, 6 patients), intraosseous (IO, 6 patients) and/or intraperitoneal cannulation (IP, 4 patients) and resuscitation was according to a defined protocol. Insertion times, maximum initial flow rates and complications were assessed. The mean insertion times were 78, 112 and 26 seconds and the mean maximum initial flow rates of crystalloid were 240, 60 and 400 mls/hour for IV, IO and IP routes respectively. One IV lasted more than 24 hours and three tissued. One IO cannula blocked, and one IP was removed because of saline extravasation. IO bolus injections were painful. Total volumes infused and time to adequate hydration varied widely and there were no correlations. The mortality was 33%, compared with 11% for 18 less severely dehydrated children. It is concluded that the IP and IO routes allow severely dehydrated children to be resuscitated without significant complications when IV access is difficult to establish.