[Intraosseous puncture in preclinical emergency medicine. Ten years experience in air rescue service].
BACKGROUND
The intraosseous puncture (IO) is a fast and safe alternative to the puncture of peripheral veins in emergency situations in children < or =6 years of age. The purpose of this paper is to summarize 10 years of experience on the prehospital use of the IO method by the Helicopter Emergency Medical Service (HEMS) "Christoph 22", Ulm.


METHODS
This was a retrospective study from 1 January 1996 to 31 December 2005.


RESULTS
Out of a total of 9,549 missions, the proportion of children was 11.1%. In 27 children (4.2% of the children < or =6 years of age) an IO puncture was performed. Patients of the IO group were younger (1.0 vs. 3.7 years of age; p<0.001) and showed a higher degree of injury severity (NACA 6 vs. 4; p<0.001) compared to the total children group. In all children of the IO group (100%), the intraosseous puncture was the method of first choice to obtain access to the vascular system by the HEMS team. In 96.4% of these cases (26/27), the first IO puncture attempt was successful - in one child, a second puncture attempt was necessary. A standardized puncture technique was performed using the proximal tibia. The time required for successful placement of the IO infusion line was 60 s or less in all cases. In 37% of the cases (10/27) the IO infusion line was used for induction of general anaesthesia; dosage and onset of administered drugs were described as being equivalent to a peripheral infusion line. In all cases, the IO needle was replaced in-hospital within 2 h by a central or peripheral iv line. No complications were observed.


CONCLUSIONS
The IO infusion technique is a simple, fast and safe alternative method for emergency access to the vascular system in children < or =6 years of age in the prehospital setting.
Helm
M
M
Abteilung für Anästhesiologie und Intensivmedizin, Bundeswehrkrankenhaus Ulm/RTH-Station Christoph 22, Oberer Eselsberg 40, 89070 Ulm. matthias-helm@extern.uni-ulm.de
Hauke
J
J
Bippus
N
N
Lampl
L
L
D000401:Aircraft; D001842:Bone and Bones; D002648:Child; D002675:Child, Preschool; D004635:Emergency Medicine; D005260:Female; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous / Q000379:methods*; D008297:Male; D009339:Needles; D018635:Rescue Work; D012189:Retrospective Studies; D013977:Tibia / Q000502:physiology; D014187:Transportation of Patients; D014947:Wounds and Injuries / Q000628:therapy*