June 2019 - Eva Schwindt

Dr. Eva Schwindt

MedUni Wien RESEARCHER OF THE MONTH June 2019

DURATION TO ESTABLISH AN EMERGENCY VASCULAR ACCESS IN NEONATES AND HOW TO ACCELERATE IT

The aim of this simulation-based study was to compare the umbilical venous catheter (UVC) and intraosseous access (IO) in real hospital settings and to assess difficulties and delaying factors for the implementation of an emergency vascular access in neonates. Fifty-nine video-recorded simulated neonatal resuscitations with the requirement for a venous access were analyzed in 16 different hospitals with real-life medical teams.

Time to establish an UVC was significantly longer than that for IO (86 vs. 199 seconds). Delaying factors for UVC implementation were mainly due to the complex approach itself, the multitude of equipment required, and uncertainties about necessary hygiene standards. Challenges in IO implementation were handling of the unfamiliar material and absence of an IO-kit in the resuscitation room.

In simulated neonatal resuscitation IO is faster to implement than UVC and shows higher potential to be improved by training of medical teams and adaptation of infrastructural settings. However, future studies regarding safety and efficacy of IO access in neonates are required.

Selected Literature

1. Schwindt EM, Hoffmann F, Deindl P, Waldhoer TJ, Schwindt JC. Duration to Establish an Emergency Vascular Access and How to Accelerate It: A Simulation-Based Study Performed in Real-Life Neonatal Resuscitation Rooms. Pediatr Crit Care Med. 2018.
2.  Perlman JM, Risser R. Cardiopulmonary resuscitation in the delivery room. Associated clinical events. Arch Pediatr Adolesc Med. 1995;149(1):20-25.
3. Wyllie J, Bruinenberg J, Roehr CC, Rudiger M, Trevisanuto D, Urlesberger B. European Resuscitation Council Guidelines for Resuscitation 2015: Section 7. Resuscitation and support of transition of babies at birth. Resuscitation. 2015;95:249-263.
4. Hansen M, Meckler G, Spiro D, Newgard C. Intraosseous line use, complications, and outcomes among a population-based cohort of children presenting to California hospitals. Pediatr Emerg Care. 2011;27(10):928-932.
5. Helm M, Haunstein B, Schlechtriemen T, Ruppert M, Lampl L, Gassler M. EZ-IO((R)) intraosseous device implementation in German Helicopter Emergency Medical Service. Resuscitation. 2015;88:43-47.
6. Horton MA, Beamer C. Powered intraosseous insertion provides safe and effective vascular access for pediatric emergency patients. Pediatr Emerg Care. 2008;24(6):347-350.
7. Maconochie IK, Bingham R, Eich C, et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 6. Paediatric life support. Resuscitation. 2015;95:223-248.
8. Abe KK, Blum GT, Yamamoto LG. Intraosseous is faster and easier than umbilical venous catheterization in newborn emergency vascular access models. Am J Emerg Med. 2000;18(2):126-129.
9. Rajani AK, Chitkara R, Oehlert J, Halamek LP. Comparison of umbilical venous and intraosseous access during simulated neonatal resuscitation. Pediatrics. 2011;128(4):e954-958.