儿童及青少年骨内血管通路装置及其并发症的系统评价和Meta分析OA

Background Intraosseous(IO)vascular access,as a core alternative to failed venous puncture,can rapidly establish medication delivery routes in emergency situations.Currently,there is no systematic review of different pediatric IO devices and their related complications in domestic and international literature.Objective To investigate whether different IO devices in children affect puncture success rates and complications.Design Systematic review.Methods Chinese search terms(child,pediatric,intraosseous,bone marrow cavity)and their corresponding English search terms and subject headings were used to construct search strategies for different databases(Wanfang Data Knowledge Service Platform,China National Knowledge Infrastructure,China Biomedical Literature Service System,Ovid-MEDLINE,Ovid-EMBASE,EBSCO-CINAHL Complete,Cochrane Library).No language restrictions were applied,with search period from database inception to February 28,2025.Studies were included if they met all three criteria:children and adolescents(≤18 years)who received IO insertion for clinical treatment needs;reported IO device types or brands;and reported IO insertion success rates or complications.Prior to data extraction,IO device types were categorized as manual,spring-loaded,and battery-powered;IO complications were classified by timing as during insertion,during use,and post-removal.Multiple reviewers conducted back-to-back screening and data extraction.Main Outcome Measures(1)First-attempt success rate.(2)IO complication rate.Results A total of 2,616 articles were retrieved from databases.After initial screening and full-text review,75 studies describing IO devices and their puncture success rates or complications,involving 2,434 pediatric patients,were included in this analysis.These studies came from 23 countries and were published in English,Chinese,German,French,and Spanish.Among the three types of devices(manual,spring-loaded,and powered),the first-attempt and overall success rates were 86.8%(95%CI:80.4%-87.8%)and 82.7%(95%CI:80.6%-84.5%),respectively.The first-attempt success rate of powered IO access(504/575)was higher than that of manual devices(310/367),although the difference was not statistically significant(χ²=1.67,P=0.20).Within manual devices,the intraosseous needle demonstrated a significantly higher first-attempt success rate compared to both the C-shaped and J-shaped manual devices(χ²=4.96,P=0.02;χ²=46.72,P<0.01).Additionally,the overall success rate of the intraosseous needle was significantly higher than that of the J-shaped device(χ²=12.11,P=0.000 5).The overall complication rate across the three device types was 11.8%(95%CI:10.2%-13.5%).Manual devices(86/540)exhibited a significantly higher overall complication rate compared to powered devices(82/874)(χ²=13.03,P=0.003).Stratified by phase,complication rates were 11.6%(95%CI:8.5%-15.6%)during insertion,13.3%(95%CI:11.3%-15.7%)during use,and 7.1%(95%CI:4.2%-11.6%)during follow-up.During insertion,manual IO devices(18/133)had a higher complication rate than powered(16/174)and spring-loaded devices(3/11),though without statistical significance.During the use phase,manual IO devices(69/334)demonstrated a significantly higher complication rate than powered devices(53/578)(χ²=23.13,P<0.001).At follow-up,manual IO devices(6/53)again showed a higher complication rate compared to powered devices(8/145),but this difference was not statistically significant(χ²=1.20,P=0.27).Notably,spring-loaded devices exhibited the highest complication rate during insertion(27.3%),whereas manual devices were associated with a greater risk of extravasation during use compared to the other two device types.Severe complications,such as compartment syndrome,were reported in follow-up for both intraosseous needles and powered IO devices.Conclusion When resources allow,powered IO access devices may be preferred as the first choice for pediatric intraosseous infusion due to their higher success rate and lower complication profile.Manual devices(particularly intraosseous needles)represent a reasonable alternative and provide operators undergo rigorous systematic training and demonstrate proficiency.Spring-loaded devices require broader clinical application and further evaluation before definitive recommendations can be made,given the limited reported evidence in the literature.