To use intraosseous access or not to use intraosseous access: determinants of trainees' decision in paediatric emergencies.
OBJECTIVE
We aim to determine whether the duration of paediatric training and previous real life intraosseous (IO) insertion experience influence a trainee paediatrician's decision on emergency vascular access choices.


METHODS
A survey was conducted using a predesigned proforma to collect data on paediatric trainees' previous paediatric experience including IO training, and their first choice of vascular access in three hypothetical cases modified from real life scenarios.


RESULTS
Of the 105 trainees contacted, 98 participated in the survey, all of which were Advanced Paediatric Life Support Course trained, and 65 had previous real life IO needle insertion experience. Experienced trainees (i.e. with more than 6 years paediatric experience) were more likely to have previous real life experience in IO insertion (odds ratio: 5.94, 95% confidence interval: 2.25-15.72). Despite resuscitation councils' clear recommendation to use IO access in the arrested infant, only 51 participants (52%) chose IO as their first vascular access choice in this situation. Previous real life IO insertion experience significantly increased trainees' willingness to use IO as their first emergency vascular access choice (P<0.0001, Fisher's exact test; odds ratio: 10.13, 95% confidence interval: 3.62-28.35).


CONCLUSIONS
Nothing helps more than previous real life IO needle insertion experience to reduce trainee paediatricians' reluctance in using IO access in an emergency, but this experience was only found more frequently among the more experienced trainees. IO access-specific workshops may provide useful supplemental training to traditional resuscitation courses, and may reduce trainees' reluctance in its use.
Department of Paediatric Critical Care Medicine, Hospital for Sick Children, Toronto, Ontario, Canada. mils.lo@doctors.org.uk
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D002983:Clinical Competence; D016001:Confidence Intervals; D003625:Data Collection; D003657:Decision Making; D004636:Emergency Service, Hospital; D006801:Humans; D017148:Infusions, Intraosseous; D015278:Intensive Care Units, Pediatric; D007396:Internship and Residency; D016015:Logistic Models; D015999:Multivariate Analysis; D016017:Odds Ratio; D011795:Surveys and Questionnaires; D013997:Time Factors