Sang Hoon Lee
Cincinnati Children's Hospital
Background: The treatment of critically ill and injured children requires expedient vascular access. Prior studies have found that over 50% of children exceed Pediatric Advanced Life Support guidelines and undergo prolonged peripheral intravenous access attempts, which delays resuscitation. It is currently unclear why providers hesitate to use intraosseous access, which is safe, quick, and effective.
Methods: Our study assessed patient-, provider-, and environmental-level factors associated with intraosseous access use in critically ill and injured children in two parts: a video-based, retrospective, case-control study, and a prospective provider-level survey. 124 videos were reviewed in a 12-month period, with 33 cases (patients who had IO access attempted) and 91 controls (patients who did not).
Results: Comparing the groups, there was a statistical difference (p<0.05) with respect to patient age (cases were generally younger) and performance of CPR (more cases underwent CPR). There was no statistical significance between groups for years of team leader experience, number of IO-capable staff present, time of shift, GCS score, caregiver presence, or vascular access team presence. The survey assessed four construct categories (Behavioral Beliefs, Subjective Norms, Control Beliefs, and Intent) based on the Theory of Planned Behavior. Out of 214 eligible providers, 134 (63%) responded. Responses were analyzed comparing providers privileged (physicians, trauma nurses, paramedics, respiratory therapists) and non-privileged (non-trauma nurses and respiratory therapists) to place intraosseous access. Significant differences were present in all four categories between the two groups.
Conclusion: These findings suggest both knowledge and attitude gaps amenable to future study and development of educational interventions.
