Resuscitation with intraosseous lines in neonatal units

Kelsall, AW

doi:10.1136/adc.68.3_spec_no.324

Cited by 27 publications

(6 citation statements)

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“…In a noncardiac arrest lamb model, a similar linear increase and comparable peak plasma epinephrine concentrations have been observed following IO and IV administration [46]. Several cases of IO epinephrine administration in neonates, including extreme premature infants have been reported in the literature with success in achieving ROSC [48,49,50,51]. There are several different IO devices available, including manual and semi-automatic types (e.g., Cook intraosseous needle [Cook Medical, Bloomington, IN, USA], EZ-IO [Telefex Medical, Toronto, Canada]) [52].…”

Section: Epinephrine In Neonatal Resuscitationmentioning

confidence: 73%

Epinephrine in Neonatal Resuscitation

et al. 2019

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Epinephrine is the only medication recommended by the International Liaison Committee on Resuscitation for use in newborn resuscitation. Strong evidence from large clinical trials is lacking owing to the infrequent use of epinephrine during neonatal resuscitation. Current recommendations are weak as they are extrapolated from animal models or pediatric and adult studies that do not adequately depict the transitioning circulation and fluid-filled lungs of the newborn in the delivery room. Many gaps in knowledge including the optimal dosing, best route and timing of epinephrine administration warrant further studies. Experiments on a well-established ovine model of perinatal asphyxial cardiac arrest closely mimicking the newborn infant provide important information that can guide future clinical trials.

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Section: Epinephrine In Neonatal Resuscitationmentioning

confidence: 73%

Epinephrine in Neonatal Resuscitation

et al. 2019

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“…Neonates were included in some series of IO therapy [101], but only few studies examined this route in neonates and premature infants [99,102]. Successful use in an 800 g baby has been reported [103].…”

Section: Central Venous Accessmentioning

confidence: 99%

Untitled

Haas

2004

Crit Care

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The current literature on venous access in infants and children for acute intravascular access in the routine situation and in emergency or intensive care settings is reviewed. The various techniques for facilitating venous cannulation, such as application of local warmth, transillumination techniques and epidermal nitroglycerine, are described. Preferred sites for central venous access in infants and children are the external and internal jugular veins, the subclavian and axillary veins, and the femoral vein. Femoral venous cannulation appears to be the most safe and reliable technique in children of all ages, with high success and low complication rates. Evidence from the reviewed literature strongly supports the use of real-time ultrasound techniques for venous cannulation in infants and children. Additionally, in emergency situations intraosseous access has almost completely replaced saphenous cutdown procedures in children and has decreased the need for immediate central venous access.

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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.…”

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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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Resuscitation with intraosseous lines in neonatal units

Abstract: Two infants on the neonatal unit aged 143 days and 47 days with difficult venous access were successfully resuscitated from episodes of collapse using the intraosseous route.

Cited by 27 publications

References 2 publications

Epinephrine in Neonatal Resuscitation

Epinephrine in Neonatal Resuscitation

Untitled

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

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