Intraosseous Access for Neonatal and Newborn Resuscitation in the National Park Service (NPS)

Schmitt, Eric R.; Stroh, Geoff; Shalit, Marc; Campagne, Danielle

doi:10.1017/s1049023x11006285

Cited by 5 publications

(3 citation statements)

References 10 publications

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“…Currently most common recommendations in many emergency wards are IO placement if IV access cannot be achieved within three attempts or 90 seconds (1). The intra-osseous route serves as an appropriate venous access site; however, delivery flow rate of large amounts of crystalloid solutions is limited (2-4). …”

Section: Introductionmentioning

confidence: 99%

Appearance Time of Methylene Blue in the Aorta: Intra-osseous vs Peripheral Intravenous Route

Hosseinpour

Khodaiari

2012

Trauma Mon

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Background:The intra-osseous (IO) route serves as an appropriate venous access site if access is needed in an emergency.Objectives:In this study, we compared the appearance time of methylene blue (MB) in the aorta following IO and peripheral intravenous (IV) routes in a rabbit model to assess a novel idea and compare the speed of IV and IO route of serum delivery into the main circulation.Materials and Methods:Twenty rabbits were used in our study. They were divided into two groups (odds as G1, n=10, evens as G2, n=10). After laparotomy, the aorta was located and cannulated by a 16 gauge angiocatheter. For IV injection in GII, the marginal vein of either ear was accessed. For IO injection in G1, the medial surface of the proximal extremity of left tibia was used. Once satisfied with positioning, 10 ml of methylene blue solution at a concentration of 10 mg /ml was injected and the time was recorded. The time taken from injection to appearance of MB in the aorta was measured.Results:All rabbits survived until the end of the experiment. There was no significant difference between the groups regarding the body weight. There was no significant difference between mean time of dye entry into the aorta in either group. It was 9.66 ± 2.51 seconds in G1 and 10.24 ± 1.95 seconds in G2 (P = 0.56).Conclusions:Our study demonstrated that there was no significant difference between the time taken for MB to reach the central circulation via IO or IV routes.

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Section: Introductionmentioning

confidence: 99%

Appearance Time of Methylene Blue in the Aorta: Intra-osseous vs Peripheral Intravenous Route

Hosseinpour

Khodaiari

2012

Trauma Mon

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“…Outside the delivery room, IO can be a primary route of administration of fluids or medications during neonatal emergencies. [4][5][6][7][8][9] Intraosseous access is more expedient than peripheral venous access, 10 and operator skill levels in the emergency department (ED) do not affect success rates for IO placement. 11 Compared with adults, children have increased superficial soft tissue and smaller compressible vasculature, which can render venous access challenging, particularly when in shock.…”

mentioning

confidence: 99%

“…For neonatal patients, the 2020 International Liaison Committee on Resuscitation guideline on neonatal life support recommends an umbilical vein catheter (UVC) as the primary method of vascular access during resuscitation in the delivery room, with IO as an alternative. Outside the delivery room, IO can be a primary route of administration of fluids or medications during neonatal emergencies 4–9 . Intraosseous access is more expedient than peripheral venous access, 10 and operator skill levels in the emergency department (ED) do not affect success rates for IO placement 11 …”

mentioning

confidence: 99%

Use of Intraosseous Access in Neonatal and Pediatric Retrieval—Neonatal and Pediatric Emergency Transfer Service, New South Wales

Joerck

Wilkinson

Angiti³

et al. 2023

Pediatr Emer Care

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Objectives Pediatric patients who are critically unwell require rapid access to central vasculature for administration of life-saving medications and fluids. The intraosseous (IO) route is a well-described method of accessing the central circulation. There is a paucity of data surrounding the use of IO in neonatal and pediatric retrieval. The aim of this study was to review the frequency, complications, and efficacy of IO insertion in neonatal and pediatric patients in retrieval. Methods A retrospective review of cases referred to neonatal and pediatric emergency transfer service, New South Wales over the epoch 2006 to 2020. Medical records documenting IO use were audited for patient demographic data, diagnosis, treatment details, IO insertion and complication statistics, and mortality data. Results Intraosseous access was used in 467 patients (102 neonatal/365 pediatric). The most common indications were sepsis, respiratory distress, cardiac arrest, and encephalopathy. The main treatments were fluid bolus, antibiotics, maintenance fluids, and resuscitation drugs. Return of spontaneous circulation after resuscitation drugs occurred in 52.9%; perfusion improved with fluid bolus in 73.1%; blood pressure improved with inotropes in 63.2%; seizures terminated with anticonvulsants in 88.7%. Prostaglandin E1 was given to eight patients without effect. Intraosseous access–related injury occurred in 14.2% of pediatric and 10.8% of neonatal patients. Neonatal and pediatric mortality rates were 18.6% and 19.2%, respectively. Conclusions Survival in retrieved neonatal and pediatric patients who required IO is higher than previously described in pediatric and adult cohorts. Early insertion of an IO facilitates early volume expansion, delivery of critical drugs, and allows time for retrieval teams to gain more definitive venous access. In this study, prostaglandin E1 delivered via a distal limb IO had no success in reopening the ductus arteriosus.

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Offene Fragen im Bereich der Versorgung und Reanimation von Neugeborenen

Schwindt¹,

Heinzel

Hoffmann

et al. 2016

Monatsschr Kinderheilkd

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Intraosseous Access for Neonatal and Newborn Resuscitation in the National Park Service (NPS)

Abstract: Abbreviations: ALS = advanced life support IO = intraosseous IV = intravenous UVS = umbilical vein catheter

Cited by 5 publications

References 10 publications

Appearance Time of Methylene Blue in the Aorta: Intra-osseous vs Peripheral Intravenous Route

Appearance Time of Methylene Blue in the Aorta: Intra-osseous vs Peripheral Intravenous Route

Use of Intraosseous Access in Neonatal and Pediatric Retrieval—Neonatal and Pediatric Emergency Transfer Service, New South Wales

Offene Fragen im Bereich der Versorgung und Reanimation von Neugeborenen

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