Fat embolism after intraosseous catheters in pediatric forensic autopsies

Abstract

In our center, we performed the autopsy of a child who died from drowning and presented, at autopsy, a major pulmonary fat embolism (PFE). A cardiopulmonary resuscitation (CPR) was performed, including infusion by intraosseous catheter (IIC). No other traumatic lesions and diseases classically related to a risk of PFE were detected. According to some animal studies, we considered the IIC as the only possible cause for PFE. However, we could not find literature to confirm this hypothesis in humans, especially in a pediatric population. To verify the occurrence of PFE after IIC in a pediatric population, we retrospectively selected 20 cases of pediatric deaths autopsied in our center, in which a CPR was performed, without bone fractures or other possible causes of PFE: 13 cases with IIC (group A) and 7 cases without IIC (group B). Several exclusion criteria were considered. The histology slides of the pulmonary tissue were stained by Oil Red O. PFE was classified according to the Falzi scoring system. In group A, 8 cases showed PFE: 4 cases with a score 1 of Falzi and 4 cases with a score 2 of Falzi. In group B, no case showed PFE. The difference between the two groups was statistically significant. The results of our study seem to confirm that IIC can lead to PFE in a pediatric population and show that the PFE after IIC can be important (up to score 2 of Falzi). To the best of our knowledge, our study is the first specifically focused on the occurrence of PFE after IIC in a pediatric population by using autoptic data.

Nontrombotic Pulmonary Embolism: Different Etiology, Same Significant Consequences

“…In this case, when compared to that with the unreamed intramedullary nailing of diaphyseal femoral fractures, intramedullary nailing after reaming has been shown to be a safer procedure with a lower risk of systemic embolization [ 40 ]. There are case reports of pediatric patients who died after fat embolism caused by the insertion of the intraosseous catheter [ 41 ]. Cardiopulmonary resuscitation (CPR) is a well-known cause of fat embolism, due to bone injury, but also trauma to subcutaneous tissue [ 42 ].…”

Intramuscular administration of tranexamic acid in a large swine model of hemorrhage with hyperfibrinolysis

“…Furthermore, IO administration is not without risk. Case reports, as well as animal studies, report an increased risk of fat embolisms 20,21 . In addition to these limitations and risks, obtaining IV and IO access in a mass casualty scenario is limited by the volume of patients and resources available.…”

“…Case reports, as well as animal studies, report an increased risk of fat embolisms. 20,21 In addition to these limitations and risks, obtaining IVand IO access in a mass casualty scenario is limited by the volume of patients and resources available. Oral administration of TXA is alternative route, but it takes approximately 1 hour to reach therapeutic concentrations and may not be feasible in a patient suffering from traumatic injury, as they may be unable to swallow.…”