• Daniel Maxien, Stefan Wirth, Oliver Peschel, Alexander Sterzik, Sonja Kirchhoff, Uwe Kreimeier, Maximilian F Reiser, and Fabian G Mück.
• Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Marchioninistr. 15, 81377, Munich, Germany; RZM Radiologisches Zentrum München, Pippinger Str. 25, 81245, Munich, Germany. Electronic address: maxien@rzm.de.
• Resuscitation. 2019 Dec 1; 145: 1-7.

Aim Of The StudyIntraosseous vascular access is a commonly conducted procedure especially in pediatric resuscitation. Very high success rates for intraosseous (IO) devices are reported. Aim of the study was to describe the rates of malposition of intraosseous needles (ION) in pediatric cadavers via post-mortem computed tomography (PMCT).Methods212 consecutive pediatric cadavers underwent PMCT, of which 38 cadavers had visible ION and were included in the study. They were divided into two subgroups depending on their age (n = 22 infant cadavers (age <1 year) and n = 16 child cadavers (age ≥1 year)). Two independent readers evaluated the number and position of ION.ResultsIn 22 infant cadavers 34 ION were found. Malposition of at least one ION was visible in 14 subjects (64%), among which 7 cadavers (32%) even had no correctly placed ION, thus being without established vascular access. Overall, 16 of the 34 used ION devices (47%) were in malposition. 23 ION were found in 16 child cadavers. In 8 subjects (50%) at least one ION was malpositioned, among which 3 cadavers (19%) had no correctly placed ION, resulting in a complete absence of vascular access. Overall, 9 of the 23 ION devices (39%) were malpositioned.ConclusionOur study showed relatively high malposition rates for ION devices in pediatric cadavers which was not to be assumed regarding the success rates of 80% and higher in previous literature. This should be clarified by further studies in living patients.Copyright © 2019 Elsevier B.V. All rights reserved.

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