Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, London, Canada.
Department of Paediatrics, Western University, Children's Health Research Institute, London, Canada.
Prehosp Emerg Care. 2023;27(2):221-226. doi: 10.1080/10903127.2022.2072553. Epub 2022 May 13.
Access of intraosseous (IO) compartments is a commonly used technique that is an invaluable asset in emergency resuscitation. Prehospital IO success rates using semi-automatic insertion devices vary between 70 and 100% of pediatric patients. There are limited data on time to insertion and duration of IO function in the prehospital setting. Recent studies limited to the pediatric emergency department (PED) setting have also suggested that IOs may be less successful in the infant population. We explored the use of IO access for pediatric resuscitation, encompassing the prehospital and pediatric emergency department (PED) settings.
This is a retrospective review of emergency medical services (EMS) patient care reports and PED data of patients aged 0-17 years old and transported by regional ground EMS agencies in Southwestern Ontario, Canada from 2012 to 2019. Mean and median time to first insertion and IO function (from insertion to IO failure, IV access, transfer to ICU, or death) were calculated.
Successful prehospital IO access was achieved in 83.7% of patients. The median time required to achieve IO access was 4 min (IQR 3-7) and mean duration of IO function was 27.6 min (SD: 14.8). Patients less than 1 year old had fewer functional IOs (25.9% vs. 75.0%), more insertion attempts (2 vs. 1), and shorter duration of IO function (18.8 vs. 32.2 mins) than the older age group ( < 0.05).
This is the first study to provide time to IO access and IO duration in the prehospital setting, and the first prehospital evidence to suggest inferior IO function in infants <1 year old, compared to other ages. This highlights unique challenges for infants that have implications for the PED, interfacility transport, and critical care settings.
骨髓腔内（IO）通路的建立是一种常用的技术，在急救复苏中具有重要价值。使用半自动插入设备进行院前 IO 成功率在儿科患者中为 70%至 100%。关于院前环境中 IO 插入的时间和 IO 功能持续时间的数据有限。最近仅限于儿科急诊部（PED）环境的研究也表明，IO 在婴儿人群中可能成功率较低。我们探讨了在儿科复苏中使用 IO 通路的情况，涵盖了院前和儿科急诊部（PED）环境。
这是对加拿大安大略省西南部地区的地区地面紧急医疗服务（EMS）机构运送的 0-17 岁患者的 EMS 患者护理报告和 PED 数据的回顾性研究。计算了首次插入和 IO 功能（从插入到 IO 失败、IV 通路建立、转入 ICU 或死亡）的平均和中位数时间。
83.7%的患者成功进行了院前 IO 通路建立。实现 IO 通路所需的中位数时间为 4 分钟（IQR 3-7），IO 功能的平均持续时间为 27.6 分钟（SD：14.8）。年龄小于 1 岁的患者功能 IO 更少（25.9% vs. 75.0%），插入尝试更多（2 次 vs. 1 次），IO 功能持续时间更短（18.8 分钟 vs. 32.2 分钟），与年龄较大的组相比（ < 0.05）。
这是第一项提供院前环境中 IO 通路建立时间和 IO 持续时间的研究，也是第一项表明 1 岁以下婴儿 IO 功能较差的院前证据，与其他年龄组相比。这突出了婴儿面临的独特挑战，对 PED、院际转运和重症监护环境都有影响。
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