MP47: A systematic review of local complications from central and peripheral administration of vasopressors in the pediatric population

Abstract

Introduction: Vasopressors are routinely utilized to treat systemic shock, a significant source of morbidity and mortality in the pediatric population. Local tissue ischemia has been classically implicated with peripheral use of these medications. However, peripheral administration (PVC) has theoretical benefits, and avoids many of the risks associated with central venous catheter (CVC) placement. There appears to be paucity of literature in pediatrics examining this subject. We conducted a systematic review investigating local tissue complications and extravasations of both PVC and CVC administration in the pediatric population. Specifically we examined the type of vasopressor used, the site used, the duration of the infusion, and finally the overall outcome for patients. Methods: A systematic search was conducted using PubMed, Embase, Cochrane, and CINAHL databases. Terms for IV administration, specific vasopressor use, complication of interest, and pediatric population were combined. We included studies that satisfied our predetermined criteria. All search results were imported into Covidence software where the primary author conducted an initial title and abstract review. Papers that met the pre-identified criteria were selected for full text review. Papers selected for full text review were independently reviewed by two of the authors. Agreement between the authors was measured utilizing a κ statistic. Results: Our search yielded 14784 results, of which 237 were assessed for full text review. The κ between the authors is pending. 13 studies were selected for final inclusion. There were 14 patients with 15 total events. 13 were from PVC use while 2 occurred with CVC's. 11 of the 13 complications associated with PVC administration occurred through extravasation, with 2 events from local ischemia. 9 children were administered dopamine, 1 norepinephrine, and 14 were on multiple vasopressors. 3/13 events were “proximal” or occurring at or above the AC or popliteal fossa while 10/13 events were “distal”. The average time to ischemic injury or extravasation peripherally was 56.1 hours with a range of 1.5 to 360 hours. 9 of the total patients did not have any long-term sequelae. One patient had toe amputations, while two others died because of illness. One CVC patient died as a result extravasation leading to asphyxiation. Conclusion: There is a lack of significant literature reporting serious adverse events related to peripheral or central administration of vasopressors in the pediatric population.