Standard methods of fluid resuscitation include gravity infusion, IV infusion pumps, pressure bags, and the use of the manual “push-pull” syringe technique (PPT), which is commonly used in pediatric emergency care. All of these techniques have drawbacks that limit the ability of providers to achieve fluid delivery goals. Infusion pumps deliver a maximum rate of 1000 mL/hr and can only achieve 60 mL/kg over 15 min in patients weighing less than 4 kg. Gravity flow is also universally inadequate when rapid fluid delivery is required to reverse shock and hypotension. The addition of a pressure bag (PB) has been shown to speed fluid delivery, but this technique requires constant re-inflation to achieve adequate flow.
With PPT, providers may be able to achieve ACCM/PALS guidelines, but the technique is complex, labor-intensive, and can result in syringe contamination.