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Nakamura E, Takahashi S, Matsunaga S, Tanaka H, Furuta M, Sakurai A. Intravenous infusion route in maternal resuscitation: a scoping review. BMC Emerg Med 2021; 21:151. [PMID: 34861839 PMCID: PMC8642880 DOI: 10.1186/s12873-021-00546-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The concept that upper extremities can be used as an infusion route during cardiopulmonary resuscitation in pregnant women is a reasonable recommendation considering the characteristic circulation of pregnant women; however, this method is not based on scientific evidence. OBJECTIVE OF THE REVIEW We conducted a scoping review to determine whether the infusion route should be established above the diaphragm during cardiopulmonary resuscitation in a pregnant woman. DISCUSSION We included randomized controlled trials (RCTs) and non-RCTs on the infusion of fluids in pregnant women after 20 weeks of gestation requiring establishment of an infusion route due to cardiac arrest, massive bleeding, intra-abdominal bleeding, cesarean section, severe infection, or thrombosis. In total, 3150 articles from electronic database were extracted, respectively. After title and abstract review, 265 articles were extracted, and 116 articles were extracted by full-text screening, which were included in the final analysis. The 116 articles included 78 studies on infusion for pregnant women. The location of the intravenous infusion route could be confirmed in only 17 studies, all of which used the upper extremity to secure the venous route. CONCLUSION Pregnant women undergo significant physiological changes that differ from those of normal adults, because of pressure and drainage of the inferior vena cava and pelvic veins by the enlarged uterus. Therefore, despite a lack of evidence, it seems logical to secure the infusion route above the diaphragm when resuscitating a pregnant woman.
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Affiliation(s)
- Eishin Nakamura
- Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe-shi, Saitama, 350-8550, Japan. .,Japan Resuscitation Council, Maternal group, Tokyo Japan, 2-5-4 Yoyogi, Sibuya-ku, Tokyo, 151-0053, Japan.
| | - Shinji Takahashi
- Japan Resuscitation Council, Maternal group, Tokyo Japan, 2-5-4 Yoyogi, Sibuya-ku, Tokyo, 151-0053, Japan.,Department of Anesthesiology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu-shi, Chiba, 279-0021, Japan
| | - Shigetaka Matsunaga
- Japan Resuscitation Council, Maternal group, Tokyo Japan, 2-5-4 Yoyogi, Sibuya-ku, Tokyo, 151-0053, Japan.,Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe-shi, Saitama, 350-8550, Japan
| | - Hiroaki Tanaka
- Japan Resuscitation Council, Maternal group, Tokyo Japan, 2-5-4 Yoyogi, Sibuya-ku, Tokyo, 151-0053, Japan.,Department of Obstetrics and Gynecology, Mie University School of Medicine, 2-174 Edobashi, Tsu-shi, Mie, 514-8507, Japan
| | - Marie Furuta
- Japan Resuscitation Council, Maternal group, Tokyo Japan, 2-5-4 Yoyogi, Sibuya-ku, Tokyo, 151-0053, Japan.,Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho Shogo-in, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Atsushi Sakurai
- Japan Resuscitation Council, Maternal group, Tokyo Japan, 2-5-4 Yoyogi, Sibuya-ku, Tokyo, 151-0053, Japan.,Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, 30-1 Oyaguchi Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
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Mansfeld A, Radafshar M, Thorgeirsson H, Höijer CJ, Segerlantz M. Palliative Sedation via Intraosseous Vascular Access: A Safe and Feasible Way to Obtain a Vascular Access End of Life. J Palliat Med 2020; 22:109-111. [PMID: 30633698 DOI: 10.1089/jpm.2018.0398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Intraosseous (IO) access is normally reserved for emergencies and critical care conditions when venous cannulation is not possible. Nonetheless, we present a case of IO insertion to a 56-year-old man, tetraplegic for many years due to progressive spinal muscular atrophy and with refractory suffering. The IO access was used for palliative sedation with propofol in a home care setting. The patient died after 11 days of palliative care, of which the last 4 days were with palliative sedation using an IO cannula as a vascular access. No complications were noted from this route of administration. We advocate the use of IO access in the palliative care of terminal ill patients when a venous cannulation is not possible.
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Affiliation(s)
- Annica Mansfeld
- 1 Department of Palliative Care and Advanced Home Health Care, Primary Health Care Skåne, Lund, Sweden
| | - Mohammadhossein Radafshar
- 1 Department of Palliative Care and Advanced Home Health Care, Primary Health Care Skåne, Lund, Sweden
| | - Hlin Thorgeirsson
- 1 Department of Palliative Care and Advanced Home Health Care, Primary Health Care Skåne, Lund, Sweden
| | - Carl Johan Höijer
- 1 Department of Palliative Care and Advanced Home Health Care, Primary Health Care Skåne, Lund, Sweden
| | - Mikael Segerlantz
- 1 Department of Palliative Care and Advanced Home Health Care, Primary Health Care Skåne, Lund, Sweden.,2 Department of Clinical Sciences Lund, Faculty of Medicine, Institute for Palliative Care, Lund University, Lund, Sweden
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Ma Y, You Y, Jiang X, Lin X, Chen Y. Parallel transverse uterine incisions combined with cell salvage minimized bleeding in a patient with pernicious placenta previa and an unexplained decrease in hemoglobin after transfusion of allogeneic red blood cells: A case report. Medicine (Baltimore) 2019; 98:e15434. [PMID: 31045807 PMCID: PMC6504319 DOI: 10.1097/md.0000000000015434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE The incidence of pernicious placenta previa (PPP) and placenta accreta (PA) is increasing in China. Excessive blood loss in these women is an important cause of maternal death and emergency hysterectomy. Performing a traditional cesarean section (CS) in women with PPP is stressful for obstetricians because avoiding cutting the placenta is difficult. As a result, sudden life-threatening bleeding may be encountered. Therefore, there is an urgent need to establish a novel operative method for PPP and PA that is safe for both the mother and neonate, and less stressful for the surgeon. PATIENT CONCERNS We report an extremely rare case of PPP and PA complicated with anemia and an unexplained decrease in the hemoglobin (Hb) levels after transfusion of 3 units of allogeneic red blood cells. DIAGNOSES The patient was diagnosed with unexplained anemia, and hemolysis resulting from donor red blood cell transfusion was suspected preoperatively. INTERVENTIONS To minimize blood loss for safety, a new operative technique, parallel transverse uterine incisions (PTUI) in CS (PTUI CS), was used under general anesthesia in this case. Inhaled volatile sevoflurane was used for uterine relaxation during PTUI. Cell salvage was also used. OUTCOMES PTUI CS combined with cell salvage effectively reduced bleeding and preserved the uterus in our patient. Sevoflurane was effective for uterine relaxation during PTUI CS. LESSONS If PPP and PA are suspected, placental magnetic resonance imaging is recommended for definitively determining whether a transverse fundal incision can be made. If feasible, we strongly recommend that PTUI CS combined with cell salvage are used to minimize bleeding for high-risk patients with PPP and PA complicated with anemia and an unexplained decrease in Hb levels after transfusion of 3 units of allogeneic red blood cells. Anesthesiologists should be vigilant to maintain uterine relaxation from the time of delivery of the neonate to a second transverse incision in the lower segment of the uterus. This is a key element of successful PTUI CS. Additionally, the use of intraoperative cell salvage is recommended when it can be expected to reduce the likelihood of donor red cell transfusion.
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Affiliation(s)
| | - Yong You
- Department of Gynecology and Obstetrics
| | | | | | - Yan Chen
- Department of Radiology, West China Second University Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan Provence, China
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Engels PT, Passos E, Beckett AN, Doyle JD, Tien HC. IV access in bleeding trauma patients: a performance review. Injury 2014; 45:77-82. [PMID: 23352673 DOI: 10.1016/j.injury.2012.12.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 12/18/2012] [Accepted: 12/28/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND Exsanguinating haemorrhage is a leading cause of death in severely injured trauma patients. Management includes achieving haemostasis, replacing lost intravascular volume with fluids and blood, and treating coagulopathy. The provision of fluids and blood products is contingent on obtaining adequate vascular access to the patient's venous system. We sought to examine the nature and timing of achieving adequate intravenous (IV) access in trauma patients requiring uncrossmatched blood in the trauma bay. METHODS We performed a retrospective chart review of all patients admitted to our trauma centre from 2005 to 2009 who were transfused uncrossmatched blood in the trauma bay. We examined the impact of IV access on prehospital times and time to first PRBC transfusion. RESULTS Of 208 study patients, 168 (81%) received prehospital IV access, and the on-scene time for these patients was 5 min longer (16.1 vs 11.4, p<0.01). Time to achieving adequate IV access in those without any prehospital IVs occurred on average 21 min (6.6-30.5) after arrival to the trauma bay. A central venous catheter was placed in 92 (44%) of patients. Time to first blood transfusion correlated most strongly with time to achieving central venous access (Pearson correlation coefficient 0.94, p<0.001) as opposed to time to achieving adequate peripheral IV access (Pearson correlation coefficient 0.19, p=0.12). CONCLUSIONS We found that most bleeding patients received a prehospital IV; however, we also found that obtaining prehospital IVs was associated with longer EMS on-scene times and longer prehospital times. Interestingly, we found that obtaining a prehospital IV was not associated with more rapid initiation of blood product transfusion. Obtaining optimal IV access and subsequent blood transfusion in severely injured patients continues to present a challenge.
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Affiliation(s)
- Paul T Engels
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada; Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
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Evaluation of the sternal intraosseous route as alternative emergency vascular access for the dental office: a manikin and cadaver model pilot study. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 116:686-91. [PMID: 24120909 DOI: 10.1016/j.oooo.2013.07.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Revised: 06/08/2013] [Accepted: 07/30/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate 2 sternal intraosseous access devices as alternatives to emergency intravenous access for dentists, using a manikin and a cadaver model. STUDY DESIGN A group of 37 students performed a sternal intraosseous access on a manikin using a Vidacare kit including a puncture template and a prepuncture skin incision. Five months later, 9 of the students used the Vidacare and 8 used an Illinois needle (without template and incision) on adult human cadavers. India ink was injected as a tracer. RESULTS Shorter times were recorded on cadavers compared with manikins in both systems. One Vidacare puncture ended subcutaneously. Two Illinois needle punctures perforated the sternum, one with intense mediastinal ink traces. Vidacare punctures took longer compared with Illinois needle punctures (medians, 32 vs 12 seconds; P = .0002). CONCLUSIONS Template use to identify the sternal puncture position, combined with additional prepuncture skin incision, may be more efficient and less predisposed to severe complications for dentists' emergency use.
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Santos D, Carron PN, Yersin B, Pasquier M. EZ-IO(®) intraosseous device implementation in a pre-hospital emergency service: A prospective study and review of the literature. Resuscitation 2012; 84:440-5. [PMID: 23160104 DOI: 10.1016/j.resuscitation.2012.11.006] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 11/01/2012] [Accepted: 11/09/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Intraosseous access is increasingly recognised as an effective alternative vascular access to peripheral venous access. We aimed to prospectively study the patients receiving prehospital intraosseous access with the EZ-IO(®), and to compare our results with those of the available literature. METHODS Every patient who required an intraosseous access with the EZ-IO from January 1st, 2009 to December 31st, 2011 was included. The main data collected were: age, sex, indication for intraosseous access, localisation of insertion, success rate, drugs and fluids administered, and complications. All published studies concerning the EZ-IO device were systematically searched and reviewed for comparison. RESULTS Fifty-eight patients representing 60 EZ-IO procedures were included. Mean age was 47 years (range 0.5-91), and the success rate was 90%. The main indications were cardiorespiratory arrest (74%), major trauma (12%), and shock (5%). The anterior tibia was the main route. The main drugs administered were adrenaline (epinephrine), atropine and amiodarone. No complications were reported. We identified 30 heterogeneous studies representing 1603 EZ-IO insertions. The patients' characteristics and success rate were similar to our study. Complications were reported in 13 cases (1.3%). CONCLUSION The EZ-IO provides an effective way to achieve vascular access in the pre-hospital setting. Our results were similar to the cumulative results of all studies involving the use of the EZ-IO, and that can be used for comparison for further studies.
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Affiliation(s)
- David Santos
- Emergency Service, Lausanne University Hospital, Switzerland.
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de Vogel J, Heydanus R, Mulders AGM, Smalbraak DJC, Papatsonis DNM, Gerritse BM. Lifesaving intraosseous access in a patient with a massive obstetric hemorrhage. AJP Rep 2011; 1:119-22. [PMID: 23705100 PMCID: PMC3653529 DOI: 10.1055/s-0031-1293514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2011] [Accepted: 08/15/2011] [Indexed: 12/11/2022] Open
Abstract
A 42-year-old, gravida 1, para 0 woman was induced at a gestational age of 41 weeks because of post-term dates. The fourth stage of delivery was complicated by a massive hemorrhage. The uncontrollable persisting amount of blood loss led to hypovolemic shock and cardiopulmonary arrest. Lifesaving extra access was gained through an intraosseous needle in the proximal tibia. We therefore advocate including the use of an intraosseous needle as an additional route for intravascular volume replacement in case of peripartum hemorrhage.
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Affiliation(s)
- Joey de Vogel
- Department of Obstetrics and Gynecology, Amphia Hospital Breda, Breda, The Netherlands
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