Smith Robert, Davis N, Bouamra Omar, Lecky Fiona
North West Deanery, 6 Broadoaks Road, Sale, Cheshire M33 7SR, UK.
Injury. 2005 Sep;36(9):1034-8; discussion 1039. doi: 10.1016/j.injury.2004.11.008.
Intraosseous lines are a reliable and rapid tool for obtaining vascular access in emergency situations, particularly in children. Their use is recommended when intravenous access cannot be easily secured and there is a need for fluid or pharmacological resuscitation. Training in this technique is included in the Advanced Trauma Life Support (ATLS) and Advanced Paediatric Life Support course (APLS) provider courses. The objective of this study is to analyse the national use of intraosseous lines in paediatric trauma in England and Wales. Data has been collected from the Trauma Audit and Research Network (TARN) group longitudinally over 14 years from 1988 to 2002. From 23,489 paediatric trauma cases, intraosseous lines were used in only 129 patients. Compared with the remainder of the paediatric data, we found that these were the younger (1-6 years), more severely injured patients (higher ISS, lower GCS, higher head, thorax, and abdominal AIS). The mortality of these patients was high at 64% compared with 4% overall. IO line use was greater in general than in Paediatric hospitals, perhaps due to good intravenous access skills in paediatric centres. We recommend that intraosseous line use should be a skill available to everybody involved in paediatric trauma resuscitation, particularly those who may not have refined paediatric intravenous cannulation skills.
骨髓内输液通道是在紧急情况下获取血管通路的一种可靠且快速的工具，尤其是在儿童中。当难以轻易建立静脉通路且需要进行液体或药物复苏时，建议使用骨髓内输液通道。这项技术的培训包含在高级创伤生命支持（ATLS）和高级儿科生命支持课程（APLS）提供者课程中。本研究的目的是分析英格兰和威尔士骨髓内输液通道在儿童创伤中的全国使用情况。从1988年到2002年的14年间，我们从创伤审计与研究网络（TARN）组纵向收集了数据。在23489例儿童创伤病例中，仅129例患者使用了骨髓内输液通道。与其余儿童数据相比，我们发现这些患者年龄更小（1至6岁），受伤更严重（损伤严重度评分更高、格拉斯哥昏迷评分更低、头部、胸部和腹部简明损伤定级更高）。这些患者的死亡率高达64%，而总体死亡率为4%。骨髓内输液通道的使用在综合医院一般比在儿科医院更多，这可能是由于儿科中心具备良好的静脉穿刺技能。我们建议，骨髓内输液通道的使用应成为参与儿童创伤复苏的每个人都具备的一项技能，尤其是那些可能没有熟练掌握儿科静脉插管技能的人员。
