儿童骨内血管通路临床情境及用药种类的范围综述OA

Background Intraosseous(IO)vascular access,as a"non-collapsible vascular system",provides a reliable route for fluid and drug administration even during peripheral circulatory failure.However,significant variations exist across institutions in clinical indications and drug utilization practices for IO access.Objective To systematically review clinical scenarios and drug categories used in pediatric and adolescent IO applications,aiming to standardize and promote broader implementation of IO access.Design Scoping review.Methods This review included children and adolescents requiring IO access for clinical treatment,with reported clinical contexts or fluid types administered via IO.Systematic searches were conducted in CNKI,Wanfang Data,SinoMed,MEDLINE,EMBASE,CINAHL Complete,Cochrane Library,and official websites of the American Heart Association(AHA),European Resuscitation Council(ERC),International Liaison Committee on Resuscitation(ILCOR),and Australian and New Zealand Resuscitation Council(ANZCOR).Databases were searched from inception to February 28,2025,with no language restrictions.Literature was managed using Rayyan software.Initial screening,full-text review,and data extraction were performed independently by two reviewers,with discrepancies resolved through discussion.Clinical contexts and fluid descriptions from included studies were extracted,and indications and drug categories were synthesized into core points.Where explicit indications were absent,disease diagnoses,clinical states,or venous conditions prompting IO use were extracted.Main Outcome Measures Clinical scenarios for IO use and the types of medications administered via IO.Results A total of 150 primary studies and 6 secondary sources(guidelines,expert consensus,and monographs)were included.Publications were distributed as follows:29.33%pre-2000,22.67%between 2000-2010,and 48%up to February 2025.Study types included 6 interventional studies(199 patients),82 case reports(99 patients),42 case series(1 953 patients),and 20 cohort,case-control or cross-sectional studies(3 207 patients).Explicit IO indications were extracted only from secondary sources,yielding core indications:(1)Acute critical conditions,such as cardiopulmonary emergencies,shock/circulatory crises,traumatic emergencies,and specific neurological or toxicological emergencies;(2)Emergency scenarios with failed venous access:① Two unsuccessful peripheral venous attempts;② Failed venous access within 5 minutes of attempted establishment.A total of 148 primary studies reported disease diagnoses or clinical states prompting IO use,with 4 153 diagnoses extracted:circulatory system diseases(52.42%),respiratory(19.05%),neurological(8.33%),traumatic(5.37%),other systems(2.28%)(digestive,infectious,metabolic,poisoning and environmental exposure,etc.)accounted for 2.28%(107 cases),and unspecified classification accounted for 16.45%(683 cases).Venous status was documented in 103 studies,detailing failed attempts,time limits for venous access,accidental venous loss,or scenarios requiring multiple venous accesses.Based on the WHO Anatomical Therapeutic Chemical(ATC)classification,61 drugs across 9 categories were administered via IO.Conclusion Pediatric and adolescent IO indications remain primarily focused on resuscitation scenarios or emergency situations with failed venous access.Both emergency,routine,and radiological drugs can be safely administered via IO routes.