Complications following prehospital intraosseous cannulation very rare, suggests study

Recent study investigated long-term complications associated with prehospital intraosseous cannulation following European Resuscitation Council guidelines. The study focused on the risk of complications such as osteomyelitis, osteonecrosis, or compartment syndrome. Data from Danish health registries were analyzed for patients who underwent prehospital intraosseous cannulation from January 2016 to December 2019. Of the 5,387 patients who received intraosseous access, 375 were lost to follow-up. Long-term complications were rare, occurring in less than 0.1% of cases. No cases of complications were reported in children, and less than five adults experienced complications, none of which appeared later than 175 days post-cannulation.

Data Sources and Analysis

The study encompassed a population of almost six million individuals over four years, utilizing nationwide health registers to link individual-level data. Data sources included the Prehospital Patient Record system, Danish National Patient Registry, and Civil Personal Registry. Results indicated no correlation between sex, diagnosis, or drug administration and the development of long-term complications. The most commonly administered drugs via intraosseous access were adrenaline, fentanyl, sodium chloride, and others.

Study Limitations

Potential limitations of the study included non-standardized data, incomplete registration of IO access, and diagnoses, leading to potential underestimation of cannulations and complications. The study design enabled only associations, not causality. The follow-up period of 180 days may have limited detection of certain complications, and reliance on diagnostic codes in the Danish National Patient Registry could impact accuracy.

Conclusion and Implications

Overall, the study concluded that complications following prehospital intraosseous cannulation are very rare, indicating the safety of the procedure across age groups. The findings are essential for healthcare professionals involved in IO access and may help alleviate reluctance in its use due to perceived complications. The study's strengths lie in its nationwide scope, data linkage, and large sample size, providing valuable insights into long-term complications associated with prehospital intraosseous cannulation.

Key Points

- The study focused on long-term complications associated with prehospital intraosseous cannulation following European Resuscitation Council guidelines, analyzing data from Danish health registries for patients from 2016 to 2019.

- Of the 5,387 patients who received intraosseous access, less than 0.1% experienced rare long-term complications such as osteomyelitis, osteonecrosis, or compartment syndrome, with no reported cases in children and fewer than five cases in adults.

- Data analysis did not find any correlation between sex, diagnosis, or drug administration and the development of long-term complications following intraosseous cannulation. - The most commonly administered drugs through intraosseous access were adrenaline, fentanyl, sodium chloride, and others, indicating the widespread use of this method for drug delivery.

- Study limitations included non-standardized data, incomplete registration of intraosseous access and diagnoses, limitations on detecting certain complications within the 180-day follow-up period, and potential accuracy issues with diagnostic codes in the Danish National Patient Registry.

- The study's nationwide scope, large sample size, and data linkage allowed for valuable insights into the safety of prehospital intraosseous cannulation, emphasizing the rarity of complications and advocating for its continued use in emergency medical situations.

Reference –

L. B. Petersen et al. (2024). An Assessment Of Long-Term Complications Following Prehospital Intraosseous Access: A Nationwide Study.. *Resuscitation*, 110454 . https://doi.org/10.1016/j.resuscitation.2024.110454.