PREHOSPITAL INTRAOSSEOUS PUNCTURE - EXPER IENCE OF A RESCUE HELICOPTER PROGRAM

In prehospital emergency treatment, the timely establishment of a secu re vascular access, especially in infants and small children, can be d ifficult or even impossible. An alternative to the puncture of periphe ral or central veins is intraosseous (IO) puncture [6, 7]. However, ex perience with this method in prehospital emergency medicine within the Federal Republic of Germany is extremely limited at present [25]. Aft er intensive theoretical and practical training of our trauma anaesthe siologists, IO puncture was introduced in our rescue helicopter progra m ''Christoph 22'' as an alternative to peripheral or central venous p uncture in the prehospital treatment of patients up to 6 years of age. IO puncture is indicated after a maximum of three failed peripheral v enous puncture attempts. The purpose of this study was to collect data and summarise first-hand experience on the prehospital use of the IO method as well as the practicability of our prescribed IO puncture alg orithm in order to subject them to critical review and evaluation. Mat erials and methods. A restrospective study by the rescue helicopter se rvice ''Christoph 22'' was carried out for the period 1 June 1993-31 A ugust 1995. Results. In a total of 1,455 primary rescue missions flown , the proportion of patients less than or equal to 6 years of age, was 6.2% (n=90). Ten patients in this partial collective (11.1%) were sub jected to IO puncture (Fig. 3). In all of these cases (10/10), the fir st IO puncture attempt was successful. A standardized puncture techniq ue was performed using the proximal tibia [9]. The time required to su ccessful placement of the IO infusion line was less than or equal to 6 0 s in all cases. Complications, especially incorrect needle position, did not occure during the study period. Materials infused by IO infus ion before hospitalisation included crystalloids (Lactated Ringer's, P ad OP(TM)) as well as colloids (hydroxyethylstarch, human albumin), ad renaline, atropine, ketamine, thiopentone, diazepam, fentanyl, succiny lcholine, and vecuronium (Table 3). Prehospital induction of general a naesthesia using the IO infusion line was required by 2/10 children; d osage and onset of administered drugs was described by the trauma anae sthesiologists as being similar to that using an IV infusion line. Sev en of the patients had been treated prior to the arrival of the rescue helicopter team by other emergency medical personnel; in all of these cases multiple peripheral and in 3 additional central venous puncture attempts had failed (duration of attempts: 10-50 min). Upon arrival o f the rescue helicopter, 5 of these patients had been pulseless and no n-breathing (Table 2). Conclusion. The IO infusion technique has prove n to be a simple, fast, and safe alternative method of emergent access to the vascular system.