The utilisation of intraosseous infusion in the resuscitation of paediatric major trauma patients Robert Smith a, * , N. Davis b , Omar Bouamra c , Fiona Lecky c a North West Deanery, 6 Broadoaks Road, Sale, Cheshire M33 7SR, UK b Booth Hall Childrens Hospital, Charlestown Road, Manchester, UK c Trauma Audit and Research Network (TARN) University of Manchester, Hope Hospital, Salford M68HD, UK Accepted 12 November 2004 Introduction The intraosseous route of vascular access was initi- ally discovered over 60 years ago, 5,9,19 and initially used principally on adults as well as on children. Its use declined with the advent of simple to use and reliable intravenous cannulae. 19 Although intraoss- eous access remains a useful option in adult resus- citation it is most often recommended for use in paediatric resuscitation where vascular access can be especially difficult to obtain. The American Col- lege of Surgeons Advanced Trauma Life Support Manual (ATLS) 1997 2 guidance on intraosseous access suggests it can be used in children up to 6 years of age and should be considered following two failed attempts at intravenous access or when it is impossible due to circulatory collapse. A review of Injury, Int. J. Care Injured (2005) 36, 1034—1038 www.elsevier.com/locate/injury KEYWORDS Paediatric; Intraosseous; Resuscitation Summary Intraosseous lines are a reliable and rapid tool for obtaining vascular access in emergency situations, particularly in children. Their use is recommended when intravenous access cannot be easily secured and there is a need for fluid or pharmacological resuscitation. Training in this technique is included in the Advanced Trauma Life Support (ATLS) and Advanced Paediatric Life Support course (APLS) provider courses. The objective of this study is to analyse the national use of intraosseous lines in paediatric trauma in England and Wales. Data has been collected from the Trauma Audit and Research Network (TARN) group longitudinally over 14 years from 1988 to 2002. From 23,489 paediatric trauma cases, intraosseous lines were used in only 129 patients. Compared with the remainder of the paediatric data, we found that these were the younger (1—6 years), more severely injured patients (higher ISS, lower GCS, higher head, thorax, and abdominal AIS). The mortality of these patients was high at 64% compared with 4% overall. IO line use was greater in general than in Paediatric hospitals, perhaps due to good intravenous access skills in paediatric centres. We recommend that intraosseous line use should be a skill available to everybody involved in paediatric trauma resuscitation, particularly those who may not have refined paediatric intravenous cannulation skills. # 2004 Published by Elsevier Ltd. * Corresponding author. Tel.: +44 161 905 1758. E-mail address: rob@smith47r.freeserve.co.uk (R. Smith). 0020–1383/$ — see front matter # 2004 Published by Elsevier Ltd. doi:10.1016/j.injury.2004.11.008