Successful Cerebral CT Angiography Via Intraosseous Contrast Administration in an 18-Month-Old Child with Acute Stroke

Introduction

Whenever intravenous (IV) access cannot be achieved in a life-threatening situation, intraosseous (IO) access is the established method of choice for a rapid and safe infusion therapy in both adults and children for the delivery of fluids, medications, and blood products (Tobias JD, Ross AK. Anesth Analg. 2010; 110(2): 391–401). IO access is approved “to administer any substance that is infusible intravenously” (Dornhofer P, Kellar JZ, StatPearls Publishing; July 26, 2021). Nevertheless, IO contrast administration has rarely been used due to existing barriers including the “perception that nurses [and doctors] are not familiar or supportive of IO access and a lack of physician confidence regarding the appropriate indications for IO access” (James Cheung W et al., Acad Emerg Med. 2014; 21(3): 250–256). IO contrast administration or lysis therapy has so far only been described in a few case reports (Krähling H et al., Neuroradiology. 2021; 63(6): 967–970) and one case series in adult patients only (Winkler M et al., J Cardiovasc Comput Tomogr. 2017; 11(3): 203–207). Apart from these few descriptions, there is currently no report of an IO contrast administration or IO thrombolytic therapy in children. We report on an 18-month-old girl who suffered an acute cardio-embolic stroke and underwent emergency head and neck CT angiography with IO contrast administration followed by successful IO thrombolysis.

Publication History

Article published online:
04 July 2022