Extract:
Peripheral administration of vasoactive medications is often required in critically ill children when rapid hemodynamic support is needed and central venous access is not immediately available (Mooli RK, et al., Glob Pediatr Health. 2021; 8: 2333794X211 022250). This situation is particularly common during early resuscitation or interhospital transport (Levy RA et al, Pediatr Crit Care Med. 2022; 23: 618–625). Although short-term peripheral vasopressor administration may be feasible under close monitoring, extravasation remains an important complication and may lead to tissue ischemia, necrosis, and, in severe cases, compartment syndrome (Hackenberg RK et al, Dtsch Arztebl Int. 2021; 118: 547–554; Dufficy M et al, J Hosp Med. 2022; 17: 832–842). Vasoconstrictive agents such as epinephrine are of particular concern because extravasation can result in intense α-adrenergic vasoconstriction and rapid deterioration of tissue perfusion (Plum M, et al, P T. 2017; 42: 581–585).
Reference:Eren ME, Durak Aslan A, Eyduran E, Babaev N, Işılgan E, Kum AS, Havan M, Kendirli T. Acute Compartment Syndrome of the Forearm and Hand Following Epinephrine Extravasation in an Infant. Klin Padiatr. 2026 Oct 19. English. doi: 10.1055/a-2975-0135. Epub ahead of print. PMID: 42896597.