Serious Complications of Intraosseous Access during Infant Resuscitation

Moláček, Jiří; Houdek, Karel; Opatrný, Václav; Fremuth, Jiří; Šašek, Lumír; Treskova, Inka; Třeška, Vladislav

doi:10.1055/s-0038-1661407

Cited by 8 publications

(6 citation statements)

References 5 publications

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“…Due to the relatively low frequency of IO usage, most studies have been performed by single institutions and have not examined the indications or complications associated with age. 19,20,21,22,23 By evaluating two different age groups within the pediatric population in a multi-center fashion, while restricted to the limitations of this dataset, we have expanded our knowledge in IO usage and outcomes. Furthermore, due to physiological reasons and the different approaches that are taken in emergency settings, it may be more reasonable to examine younger children separately from older children whenever possible.…”

Section: Discussionmentioning

confidence: 99%

“…Studies have reported the most common complications of IO usage include extravasation, infection (cellulitis and osteomyelitis), compartment syndrome, lower extremity fractures, and thrombosis. 6,7,19,20,21 Many of the current published studies mainly focus on IO usage in the setting of cardiac arrest, respiratory failure, and trauma. 19,20,21,22 While these conditions are the most widely known indications for IO access in children, its use in pediatrics has expanded to include severe hemodynamic disorders, neurological compromise, shock, and severe bleeding.…”

Section: Introductionmentioning

confidence: 99%

“…6,7,19,20,21 Many of the current published studies mainly focus on IO usage in the setting of cardiac arrest, respiratory failure, and trauma. 19,20,21,22 While these conditions are the most widely known indications for IO access in children, its use in pediatrics has expanded to include severe hemodynamic disorders, neurological compromise, shock, and severe bleeding. 7,12,13,16,23 However, the frequency of its use for non-cardiac arrest indications, the type of patient population, as well as the complication rate is presently unknown.…”

Section: Introductionmentioning

confidence: 99%

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Current Utilization of Interosseous Access in Pediatrics: A Population-Based Analysis using an EHR database, TriNetX

Hoskins

Sefick

Zurca

et al. 2022

Preprint

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Background: Interosseous (IO) usage in the pediatric population has been mostly studied in the setting of cardiac arrest. Population-based studies identifying the indications and complications associated with age, however, are sparse. Results: This was a retrospective observational cohort study utilizing the TriNetX ® electronic health record data. Thirty-seven hospitals were included in the data set with 1012 patients where an IO procedure code was reported in the emergency department or inpatient setting. The cohort was split into two groups, pediatric subjects < 1 year of age and those ≥ 1 year of age. A total incidence of IO line placement of 18 per 100,000 pediatric encounters was reported. Total mortality was 31.8%, with a higher rate of mortality seen in subjects < 1 year of age (39.2% vs 29.0%; p = 0.0028). A diagnosis of cardiac arrest was more frequent in subjects < 1 year of age (51.5% vs 38.0%; p = 0.002), and a diagnosis of convulsions was more frequent in those ≥ 1 of age (28.0% vs 13.8%; p <0.01). Overall, 29 (2.9%) subjects had at least one complication. Conclusions: More IOs were placed in subjects ≥ 1 year of age, and a higher rate of mortality was seen in subjects < 1 year of age. Lower frequencies of non-cardiac diagnoses at the time of IO placement were found in both groups, highlighting IO may be underutilized in non-cardiac settings such as convulsions, shock, and respiratory failure. Given the low rate of complications seen in both groups of our study, IO use should be considered early on for urgent vascular access, especially for children less than 1 year of age.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Current Utilization of Interosseous Access in Pediatrics: A Population-Based Analysis using an EHR database, TriNetX

Hoskins

Sefick

Zurca

et al. 2022

Preprint

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“…Intraosseous access (IO) offers a fast and reliable method for achieving emergency access for fluids and drugs when peripheral venous access fails ( 1 , 3 – 5 ). Severe complications seem to be rare but include tibial fracture ( 6 ), haematoma ( 7 ), osteomyelitis ( 8 ), and extravasation of fluids and medications resulting in necrosis with compartment syndrome ( 9 ) as well as subsequent amputation ( 10 ). For adults and children beyond the neonatal setting, IO access is recommended as a first-line method of establishing vascular access in cardiac arrest and peri-arrest settings ( 11 ).…”

Section: Introductionmentioning

confidence: 99%

Intraosseous access in neonates is feasible and safe – An analysis of a prospective nationwide surveillance study in Germany

et al. 2022

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BackgroundThis was a prospective surveillance study to investigate reports on the safety and frequency of use of intraosseous (IO) access in neonates.MethodsOver a two-year period, paediatric hospitals in Germany were asked to report all cases of IO access to the nationwide Surveillance Unit for Rare Paediatric Diseases (ESPED). Hospitals reporting a case submitted responses via an anonymised electronic questionnaire, providing details on indication, success rate, system used, location, duration to first successful IO access, complications, alternative access attempts and short-term outcome. We present a subset of data for IO use in infants of less than 28 days.ResultsA total of 161 neonates (145 term and 16 preterm born infants) with 206 IO access attempts were reported. In 146 neonates (91%), IO access was successfully established, and success was achieved with the first attempt in 109 neonates (75%). There was no significant impact of gestational age or provider’s educational level on success rates. In 71 infants with successful IO access (79%), the estimated duration of placement was less than 3 min. The proximal tibia was the predominant site used. A semiautomatic battery-driven device was used in 162 attempts (88%). The most often applied medications via IO access were crystalloid fluid and adrenaline. Potentially severe complications occurred in 9 patients (6%).ConclusionWithin this surveillance study, IO access in neonates was feasible and safe. IO access is an important alternative for vascular access in neonates.

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“…Despite the benefits, IO access does not come without risk. Studies have reported the most common complications of IO usage include extravasation, infection (cellulitis and osteomyelitis), compartment syndrome, lower extremity fractures, and thrombosis [6,7,[20][21][22].…”

Section: Introductionmentioning

confidence: 99%

Current utilization of interosseous access in pediatrics: a population-based analysis using an EHR database, TriNetX

et al. 2022

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Background When central or peripheral intravenous access cannot be achieved in a timely manner, intraosseous (IO) access is recommended as a safe and equally effective alternative for pediatric resuscitation. IO usage and its complications in the pediatric population have been primarily studied in the setting of cardiac arrest. However, population-based studies identifying noncardiac indications and complications associated with different age groups are sparse. Results This was a retrospective observational cohort study utilizing the TriNetX® electronic health record data. Thirty-seven hospitals were included in the data set with 1012 patients where an IO procedure code was reported in the emergency department or inpatient setting. The cohort was split into two groups, pediatric subjects < 1 year of age and those ≥ 1 year of age. A total incidence of IO line placement of 18 per 100,000 pediatric encounters was reported. Total mortality was 31.8%, with a higher rate of mortality seen in subjects < 1 year of age (39.2% vs 29.0%; p = 0.0028). A diagnosis of cardiac arrest was more frequent in subjects < 1 year of age (51.5% vs 38.0%; p = 0.002), and a diagnosis of convulsions was more frequent in those ≥ 1 of age (28.0% vs 13.8%; p <0.01). Overall, 29 (2.9%) subjects had at least one complication. Conclusions More IOs were placed in subjects ≥ 1 year of age, and a higher rate of mortality was seen in subjects < 1 year of age. Lower frequencies of noncardiac diagnoses at the time of IO placement were found in both groups, highlighting IO may be underutilized in noncardiac settings such as convulsions, shock, and respiratory failure. Given the low rate of complications seen in both groups of our study, IO use should be considered early on for urgent vascular access, especially for children less than 1 year of age.

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Serious Complications of Intraosseous Access during Infant Resuscitation

Cited by 8 publications

References 5 publications

Current Utilization of Interosseous Access in Pediatrics: A Population-Based Analysis using an EHR database, TriNetX

Current Utilization of Interosseous Access in Pediatrics: A Population-Based Analysis using an EHR database, TriNetX

Intraosseous access in neonates is feasible and safe – An analysis of a prospective nationwide surveillance study in Germany

Current utilization of interosseous access in pediatrics: a population-based analysis using an EHR database, TriNetX

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