Intraosseous infusion in paediatric emergency medical care and anaesthesia

The timely establishment of venous access in infants and toddlers can prove a particularly challenging task. In the 1940s, the technique of intraosseous infusion became established as an effective and safe means of delivering drugs, fluids and blood products. While the international guidelines for paediatric emergency medical care over the last two decades have accorded intraosseous infusion a high priority in this field, the technique is increasingly being advocated as an option for particularly difficult vascular access in the areas paediatric anaesthesia and perioperative care. This development is being furthered by the availability of modern, simple and safe canulation systems. According to the current Guidelines for Emergency Medical Care of the European Resuscitation Council intraosseous infusion is indicated whenever access to the circulation is imperative and a maximum of three cannulation attempts have failed (e.g. in cardiorespiratory arrest, acute haemodynamic instability, etc.). Additional indications include prolonged laryngospasm and massive airway bleeding in a child with no established iv-line, induction of anaesthesia in a child with a full stomach (rapid sequence induction) and failed cannulation. Semi-elective use of intraosseous infusion in non-critically ill children, such as in failed peripheral venous access after inhalational induction of anaesthesia should remain an option for individual cases only. Successful utilisation of the intraosseous infusion technique in paediatric emergency medical care and anaesthesia requires immediate availability of the equipment, regular training in its use, and unequivocal guidelines for its application in the specific medical setting). The Scientific Working Group for Paediatric Anaesthesia of the German Society for Anaesthesiology and Intensive Care Medicine is soon to release official guidelines on the practical use of intraosseous infusion.