A Systematic Review of Complications from Pediatric Intraosseous Cannulation

“A Systematic Review of Complications from Pediatric Intraosseous Cannulation” Bouhamdan J, Polsinelli G, Akers KG, Paxton JH. Department of Emergency Medicine, Wayne State University School of Medicine (Detroit, MI) Introduction Intraosseous (IO) infusion is a commonly-used method for obtaining vascular access in emergency situations. It involves insertion of a needle into the marrow cavity of long bones, with subsequent infusion of medications and fluids to achieve resuscitation. This procedure is known to be associated with certain complications. Despite the widespread continued use of IO cannulation for pediatric subjects, a high-quality systematic review of the literature on pediatric IO complications remains lacking. Materials & Methods Several databases were searched for studies relating to IO infusion. Inclusion criteria included: English-language, original reports on the clinical treatment of human pediatric (old) patients, which reported the presence or absence of complications identified during the clinical care of the patient. Studies with IO cannulation performed under sterile operative settings were excluded. These studies were further processed on Covidence (www.covidence.org) systematic review software. Complications identified include, but are not limited to, pain, extravasation, compartment syndrome, local infections, osteomyelitis, embolism, fractures, and device failure. We are also collecting data on patient demographics, medications infused, injection site, and indication for cannulation. Results In total, 1,647 studies were imported for screening, with 762 duplicates removed. The remaining 885 studies were individually screened by abstract review, resulting in exclusion of 462 studies due to irrelevance. The remaining 423 studies are undergoing full-text review. Fifty-one studies have already been identified that appear to be suitable for inclusion and data extraction. Conclusions We anticipate this review to contribute to an improved understanding of complications associated with IO cannulation use in the pediatric population