A Prospective Area-Based Analysis of the use of Intraosseous Access in Children

Introduction: Intraosseous (IO) access is recommended in children in cardiopulmonary arrest and in decompensated shock. There is no data on the actual use of IO access in children under such circumstance sat an area-based level. The aim of this study was to evaluate the use of IO access in children in a 1.8 million inhabitant-region of France (Poitou-Charentes) and the components influencing it. Methods: A 1-year prospective study was carried out in 5 pediatric wards and 5 emergency units with their related EMS. Primary objective was analysis of success rate. Secondary objectives were analyses of the incidence of IO insertion, and the variables that may influence success rate (age, type of IO device, and training of the physician). Results: 20 attempts of IO access were recorded in 13 children (2m.o.- 10y.o.) A large majority of them (10/13, 77%) were <2y.o. Success rates were 60% per trial and 85% per child. The incidence of IO access use was very low (<2/10,000 children). In this small cohort, neither age nor type of device was factors that affected success rate. 12 out of the 13 physicians who attempted IO access had received specific training. Conclusion: Use of IO access in children was a very rare event with a moderate success rate. 77% of children were <2y.o. No factor influencing success rate was identified. 12/13 physicians were properly trained which questions on the repetition of such training. Larger studies (national registry) are necessary to explore compliance with guidelines and analyze factors influencing success.