[Intraosseous infusions in pediatric life-threatening emergencies]

As the bone marrow is a vascular tissue which cannot collapse, it may be used as a vascular access to treat life-threatening emergencies especially in children. Two cases reported here underline the value of this life-saving procedure. Both children were 9 months old, and were admitted for severe dehydration, having lost 15 and 10% of body weight respectively. All attempts to set up an intravenous infusion in a peripheral vein failed in both. The fontanelles were closed, and the central veins (internal jugular and subclavian veins) easily accessible, however collapsed. Intraosseous infusion was decided as a last ditch procedure. A 15-gauge Mallarmé's trocar was inserted at the proximal end of the tibia. In both children, this allowed rehydration to be carried out, and, in the second child, anticonvulsive and antibiotic therapy to be started. The intraosseous line was replaced, in the first child, at the third hour, by a conventional infusion line, set up by denudation, and in the second one, by a subclavian line. This technique has few contra-indications, and the complication rate is low. However, this technique should remain limited to a few indications only.