USE OF INTRAOSSEOUS INFUSION IN THE PEDIATRIC TRAUMA PATIENT

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. We recommend early aggressive volume replacement using crystalloid, colloid and blood as indicated. Regarding infusion of fluid via IO, our experience suggests that pressure infusion devices are necessary to maintain continuous flow. Our success with administration of a wide range of pharmacological agents suggests that any drug necessary for resuscitation and stabilization of the injured child should be strongly considered for IO administration. IO placement by properly trained paramedics, nurses, and physicians in our study supports the assumption that IO is an easily mastered procedure with a minimal complication rate. We find IO to be a viable alternative, in both the prehospital and hospital setting, for achieving rapid vascular access in pediatric trauma victims. © 1993 W.B. Saunders Company. All rights reserved.