Carsten Joerck1, Rob Wilkinson1, Laura Scerri1, Tracey Lutz1,2, Raj Angiti1, Kath Browning Carmo1,2
1Newborn & paediatric Emergency Transport Service, New South Wales (NETS NSW), Australia, 2Faculty of Medicine and Health, University of Sydney, Australia
Background: Critically ill children require venous access for the administration of life saving medications and fluids. The Intraosseous (IO) route is a method of quickly accessing the central circulation. The aims of this study were to review the frequency, complications and efficacy of IO insertion in neonatal and paediatric patients in a retrieval cohort.
Methods: A retrospective review over the epoch 2006-2020. Medical records with documented IO use were reviewed for demographic data, proceduralist and hospital factors (number of attempts, level of training, level of hospital, additional access gained), patient factors (indication for IO, treatments received, injuries sustained, clinical responses to treatment) and mortality data.
Results: IO access was documented in 467 patients (102 neonatal, 365 paediatric). The most common presenting issue was sepsis; followed by respiratory distress, cardiac arrest and encephalopathy. The most common treatments were fluid bolus, antibiotics, fluids and resuscitation drugs. ROSC occurred in 52.9% of patients given resuscitation drugs; perfusion improved with fluid bolus in 73.1%; blood pressure improved with inotropes in 63.2%; seizures terminated with anticonvulsants in 88.7%. PGE1 was given to eight patients but did not result in re-opening the ductus arteriosus. IO related injury occurred in 14.2% (paediatric) and 10.8% (neonatal). Neonatal and paediatric mortality occurred in 18.6% and 19.2% respectively.
Conclusion: Early insertion of an IO facilitates early volume expansion, resuscitation drug delivery, antibiotics and anticonvulsants and facilitates venous access. PGE1 delivered via a distal limb IO is not successful in reopening the ductus arteriosus in duct-dependent congenital heart disease.