Analysing blood from intraosseous access: a systematic review

[Paediatric Life Support]

The European Resuscitation Council (ERC) Paediatric Life Support (PLS) guidelines are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations of the International Liaison Committee on Resuscitation (ILCOR). This section provides guidelines on the management of critically ill or injured infants, children and adolescents before, during and after respiratory/cardiac arrest.

European Resuscitation Council Guidelines 2021: Paediatric Life Support

These European Resuscitation Council Paediatric Life Support (PLS) guidelines, are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the management of critically ill infants and children, before, during and after cardiac arrest.

Comparison of Hematological and Biochemical Results Derived from Arterial and Venous Blood Samples in Post-Anesthetic Dogs

Simple Summary

In contrast to humans, general anesthesia is required for both surgical procedures and diagnostic imaging like magnetic resonance imaging (MRI) and computed tomography (CT) in small animals. Because the post-anesthetic period is a particularly high risk time for death, serial monitoring of biochemical and hematological parameters could be required. Blood samples could be collected from an indwelling arterial catheter to avoid stress caused by venipuncture, but studies using arterial blood for hematological and biochemical testing have been limited. The aim of this study is to compare hematological and biochemical results derived from venous and arterial blood samples, and to evaluate their clinical interchangeability in post-anesthetic dogs. We found statistically significant but clinically irrelevant differences in hemoglobin, glucose, creatinine, and calcium levels, and results from venous and arterial blood samples are not clinically interchangeable for gamma-glutamyl transpeptidase and potassium levels.

Abstract

Collecting blood from an indwelling arterial catheter may reduce stress from repeated venipuncture in patients requiring serial monitoring, but the use of arterial blood for hematological and biochemical testing remains understudied. Here, we compared hematological and biochemical results of arterial and venous blood and evaluated their clinical interchangeability. Blood samples from dogs who had recovered from anesthesia, collected by both arterial catheterization and venipuncture, were analyzed. To assess clinical acceptance between paired samples, the limit of agreement between the values derived from the arterial and venous blood samples was compared with the allowable total error (TEa) recommended for each parameter. We found no significant differences between the arterial and venous sample results for red/white blood cell and platelet counts and hematocrit, blood urea nitrogen, phosphate, total protein, albumin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, gamma-glutamyl transpeptidase, total bilirubin, sodium, potassium, and chloride levels, whereas hemoglobin, glucose, creatinine, and calcium levels differed significantly (p < 0.05). Moreover, only gamma-glutamyl transpeptidase and potassium exceeded the recommended TEa. Hematological and biochemical results derived from venous and arterial blood samples are clinically interchangeable in post-anesthetic dogs, with the exception of gamma-glutamyl transpeptidase and potassium; thus, these values should be used with caution.

Point-of-care analyses of blood samples from intraosseous access in pre-hospital critical care

BACKGROUND

Intraosseous (IO) access is used for fluid and medication administration in emergency situations when difficulties with vascular access are encountered. IO access would be readily available to take samples for point-of-care (POC) analysis, but there is scarce evidence about the reliability of POC analysis of IO samples among emergency patients. The aim of this study was to evaluate the feasibility and reliability of POC analysis of IO samples in critically ill pre-hospital patients.

METHODS

We performed a prospective, observational study in 35 critically ill pre-hospital patients. After inserting a humeral IO needle, we immediately drew an IO sample. We compared the results to an arterial sample drawn from the same patient within 5 (blood gases) or 15 (other parameters) minutes. Samples were analysed with an i-STAT® POC analyser for blood gases, acid-base balance, electrolytes, glucose and haemoglobin. The agreement between each patient's IO and arterial samples was analysed using the Bland-Altman method. The results were compared to responses about acceptable bias on a questionnaire sent to 16 experienced emergency physicians.

RESULTS

The analysis was successful for 23 patients (70%). Higher age was associated with failed analyses. The average bias was acceptable for base excess, pH, standard bicarbonate, glucose, ionized calcium and sodium. IO potassium values were systematically higher than arterial values. IO haemoglobin values had widely varying agreement.

CONCLUSION

When vascular access is challenging, IO access can be used for emergency POC analyses to help guide clinical decision-making. However, the limitations of IO POC analyses must be carefully considered.