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Charbel RC, Ollier V, Julliand S, et al. Safety of early norepinephrine infusion through peripheral vascular access during transport of critically ill children. J Am Coll Emerg Physicians Open. 2021;2(2):e12395doi: 10.1002/emp2.12395.
Charbel, R. C., Ollier, V., Julliand, S., Jourdain, G., Lode, N., Tissieres, P., & Morin, L. (2021). Safety of early norepinephrine infusion through peripheral vascular access during transport of critically ill children. Journal of the American College of Emergency Physicians open, 2(2), e12395. https://doi.org/10.1002/emp2.12395
Charbel, Ramy C, et al. "Safety of early norepinephrine infusion through peripheral vascular access during transport of critically ill children." Journal of the American College of Emergency Physicians open vol. 2,2 (2021): e12395. doi: https://doi.org/10.1002/emp2.12395
Charbel RC, Ollier V, Julliand S, Jourdain G, Lode N, Tissieres P, Morin L. Safety of early norepinephrine infusion through peripheral vascular access during transport of critically ill children. J Am Coll Emerg Physicians Open. 2021 Mar 02;2(2):e12395. doi: 10.1002/emp2.12395. eCollection 2021 Apr. PMID: 33718927; PMCID: PMC7926000.
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J Am Coll Emerg Physicians Open. 2021 Mar 02;2(2):e12395. doi: 10.1002/emp2.12395. eCollection 2021 Apr.

Safety of early norepinephrine infusion through peripheral vascular access during transport of critically ill children.

Journal of the American College of Emergency Physicians open

Ramy C Charbel, Vincent Ollier, Sebastien Julliand, Gilles Jourdain, Noëlla Lode, Pierre Tissieres, Luc Morin

Affiliations

  1. Pediatric Intensive Care Unit DMU 3 Santé de l'enfant et de l'adolescent AP-HP Paris Saclay University - Bicetre hospital Le Kremlin-Bicêtre France.
  2. Division of Pediatric and Neonatal Critical Care and Transportation AP-HP Paris Saclay University - Antoine Beclère hospital Clamart France.
  3. Division of Pediatric and Neonatal Critical Care and Transportation APHP Paris Nord - Robert Debré hospital Paris France.
  4. Institute of Integrative Biology of the Cell-CNRS CEA Paris Saclay University Gif-sur-Yvette France.

PMID: 33718927 PMCID: PMC7926000 DOI: 10.1002/emp2.12395

Abstract

STUDY OBJECTIVE: In prehospital and emergency settings, vasoactive medications may need to be started through a peripheral intravenous catheter. Fear of extravasation and skin injury, with norepinephrine specifically, may prevent or delay peripheral vasopressor initiation, though studies from adults suggest the actual risk is low. We sought to study the risk of extravasation and skin injury with peripheral administration of norepinephrine in children in the prehospital setting.

METHODS: We performed a retrospective study of pediatric patients (≤18 years) who received a vasopressor during prehospital transport. We collected data from retrieval and hospital records from 2 pediatric medical retrieval teams in the Paris/Ile-de-France region. Patients were eligible if they had documentation of distributive or obstructive shock and administration of norepinephrine through a peripheral catheter (intravenous or intraosseous) during retrieval. The primary outcomes were the occurrence of extravasation and evidence of skin injury. We also examined approach to norepinephrine administration (concentration, duration, proximal vs distal site) and hospital outcomes.

RESULTS: Over a 3-year-period, 37 pediatric patients received norepinephrine through a peripheral catheter (33 intravenous, 4 intraosseous). Median patient age was 1.8 years. Thirty-two patients (86.5%) had septic shock. The median total duration of norepinephrine infusion was almost 4 hours. One patient (2.7%, 95% confidence interval 0.5%, 13.8%) had suspected extravasation from a 24-gauge intravenous catheter in the hand, with local skin hypoperfusion. Skin changes were noted after 135 minutes of norepinephrine infusion. Perfusion normalized after catheter removal, and there were no other sequelae.

CONCLUSIONS: In a 3-year sample of pediatric patients from a large metropolitan area, we found only 1 patient with evidence of any harm with peripheral administration of norepinephrine. This finding is consistent with the adult literature but requires multicenter and multiyear investigation before a firm recommendation for this practice can be made.

© 2021 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of American College of Emergency Physicians.

Keywords: norepinephrine; pediatric; sepsis; shock; transport; vascular access

Conflict of interest statement

The authors declare no conflict of interest.

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