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Use of intraosseous infusion in the pediatric trauma patient
1Department of Emergency Services, Children's Hospital, Columbus, OH.
Insights
Intraosseous (IO) infusions provide rapid vascular access for critically ill children. This study found IO infusions to be a safe and effective resuscitation method for pediatric trauma patients when venous access is delayed.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Resuscitation
- Vascular Access
Background:
- Intraosseous (IO) infusions are vital for rapid vascular access in critically ill children.
- Limited data exists on IO efficacy in pediatric trauma patients.
Purpose of the Study:
- To evaluate a single pediatric institution's experience with IO infusions in young trauma victims.
- To analyze indications, insertion sites, complications, and outcomes of IO use in pediatric trauma.
Main Methods:
- Retrospective review of 32 pediatric trauma patients receiving IO infusions.
- Data collected included patient age, injury severity, indications, insertion sites, and outcomes.
- Analysis of medications and fluid boluses infused via IO access.
Main Results:
- IO access was used for cardiopulmonary arrest, hypovolemic shock, and neurological compromise.
- Tibia was the most common insertion site (29/32 attempts).
- Four of 32 attempts were unsuccessful; 7 of 27 patients survived without IO-related complications.
Conclusions:
- Intraosseous infusions are a rapid, safe, and simple method for short-term vascular access in pediatric trauma.
- IO infusion should be strongly considered as an alternative resuscitation route when venous access is difficult.
- Prehospital and hospital personnel can effectively utilize IO access for critically injured children.
Abstract:
Intraosseous infusions (IO) are frequently used for gaining rapid vascular access in critically ill children. Few studies exist evaluating the efficacy of this procedure in the injured child. The objective of this study was to describe one pediatric institution's experience with the procedure of IO in young trauma victims. This study evaluated indications, insertion sites, complications, infused pharmacological agents, age, injury severity, and outcome. Fifteen patients received IO placement for cardiopulmonary arrest, seven for hypovolemic shock, and five for neurological compromise. Patient ages ranged from 3 months to 10 years (mean, 2.9 years). Twenty-nine IO lines were attempted in the tibia and three in the femur. Four of 32 attempts were unsuccessful. Of 32 attempts at IO placement (5 patients received multiple attempts), 15 were started in the prehospital setting and 17 in the emergency department. Multiple resuscitation medications as well as large colloid, crystalloid, and blood boluses were successfully infused. Seven of the 27 patients survived without observed IO-related complications. This study supports the use of IO infusion by prehospital as well as hospital personnel in the initial resuscitation of critically injured children. IO has a been established as a rapid, safe, and simple method of obtaining short term vascular access in both critically ill and injured children. This route deserves primary consideration as an alternate route for fluid resuscitation in pediatric trauma patients regardless of age. IO should be placed without delay when venous access is not rapidly obtainable.(ABSTRACT TRUNCATED AT 250 WORDS)