79: Intraosseous Pressure Infusion Comparison Using a Rapid Infusion Device and a Pressure Bag In a Swine Model

Lairet, Julio; Bebarta, Vik; Lairet, Kimberly; Kacprowicz, Robert F.; Johnson, Randolph M.; Pitotti, Rebecca; Bolleter, Scotty; Bush, Anneke C.

doi:10.1016/j.annemergmed.2010.06.122

Cited by 7 publications

(3 citation statements)

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“…FASTR; FASTResponder ™ Intraosseous Device, PYNG Medical, Canada). Nevertheless, little evidence exists on the fluid resuscitation rate of different intraosseous infusion systems in adult emergency patients: The low fluid rate through these devices remains an area of debate and infusion rates between 200 and 9900 ml/h were reported according to external use of pressure bags [ 6 – 12 ]. The information provided by manufacturers' instruction manuals ranges from 30 ml/h to 120 ml/min (without pressure and with pressure) using the FASTR.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Fluid Resuscitation Rate with and without External Pressure Using Two Intraosseous Infusion Systems for Adult Emergencies, the CITRIN (Comparison of InTRaosseous infusion systems in emergency medicINe)-Study

et al. 2015

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IntroductionIntraosseous infusion is recommended if peripheral venous access fails for cardiopulmonary resuscitation or other medical emergencies. The aim of this study, using body donors, was to compare a semi-automatic (EZ-IO®) device at two insertion sites and a sternal intraosseous infusion device (FASTR™).MethodsTwenty-seven medical students being inexperienced first-time users were randomized into three groups using EZ-IO and FASTR. The following data were evaluated: attempts required for successful placement, insertion time and flow rates with and without external pressure to the infusion.ResultsThe first-pass insertion success of the EZ-IO tibia, EZ-IO humerus and FASTR was 91%, 77%, and 95%, respectively. Insertion times (MW±SD) did not show significant differences with 17±7 (EZ-IO tibia) vs. 29±42 (EZ-IO humerus) vs. 33±21 (FASTR), respectively. One-minute flow rates using external pressures between 0 mmHg and 300 mmHg ranged between 27±5 to 69±54 ml/min (EZ-IO tibia), 16±3 to 60±44 ml/min (EZ-IO humerus) and 53±2 to 112±47 ml/min (FASTR), respectively. Concerning pressure-related increases in flow rates, negligible correlations were found for the EZ-IO tibia in all time frames (c = 0.107–0.366; p≤0.013), moderate positive correlations were found for the EZ-IO humerus after 5 minutes (c = 0.489; p = 0.021) and strong positive correlations were found for the FASTR in all time frames (c = 0.63–0.80; p≤0.007). Post-hoc statistical power was 0.62 with the given sample size.ConclusionsThe experiments with first-time users applying EZ-IO and FASTR in body donors indicate that both devices may be effective intraosseous infusion devices, likely suitable for fluid resuscitation using a pressure bag. Variations in flow rate may limit their reliability. Larger sample sizes will prospectively be required to substantiate our findings.

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Section: Introductionmentioning

confidence: 99%

Comparison of the Fluid Resuscitation Rate with and without External Pressure Using Two Intraosseous Infusion Systems for Adult Emergencies, the CITRIN (Comparison of InTRaosseous infusion systems in emergency medicINe)-Study

et al. 2015

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“…23,34,35,[40][41][42] Previous research has also noted pressure bag flow rates to be superior to the rapid infuser. 23,43 The difference between PB and rapid infuser in both studies was related primarily to interruption in infusion from frequent overpressure alarms. While the rapid infuser in this present study had several subjects where the pressure did not exceed factory limits and infusion continued unimpeded, it was overall unreliable.…”

Section: Discussionmentioning

confidence: 97%

Safety of Pressurized Intraosseous Blood Infusion Strategies in a Swine Model of Hemorrhagic Shock

Auten

McEvoy

Roszko

et al. 2020

Journal of Surgical Research

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Background: Current guidelines support intraosseous access for trauma resuscitation when intravenous access is not readily available. However, safety of intraosseous blood transfusions with varying degrees of infusion pressure has not been previously characterized. Materials and methods: Adult female Yorkshire swine (Sus scrofa; n ¼ 36; mean (M): 80 kg, 95% CI: 78-82 kg) were cannulated and then bled approximately 30% total blood volume. Swine were randomly assigned to proximal humerus intraosseous blood infusion with either Rapid Infuser, or Pressure Bag, or Push-Pull methods (n ¼ 12 each). Flow rates, infusion pressures, vitals, biochemical variables, and pulmonary and renal tissue pathology were contrasted between groups. Results: Flow rates were greater for the Push-Pull strategy than Pressure Bag (96.5 mL/min versus 72.6 mL/min, P ¼ 0.02) or Rapid Infuser (96.5 mL/min versus 60 mL/min, P ¼ 0.002) strategies. The pressures generated during the Push-Pull transfusion (3058 mmHg) were greater than the other strategies (360 mmHg). After the observation period, plasma-free hemoglobin levels were higher in the Push-Pull strategy than in the Rapid Infuser (40 mg/dL versus 12 mg/dL, P ¼ 0.02) or Pressure Bag (40 mg/dL versus 12 mg/dL, P ¼ 0.01). Groups did not significantly differ in vitals, biochemical variables, or tissue pathology. Conclusions: Push-Pull conferred the highest flow rates, but with higher infusion pressures and evidence of intravascular hemolysis. Rapid Infuser and Pressure Bag infusions had no increase from baseline in plasma-free hemoglobin. Pressure Bag infusion was noted to confer an advantage in flow rates over Rapid Infuser. Intraosseous blood transfusion with pressure bags can safely bridge toward central access in the early phases of trauma resuscitation.

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“…Several studies have shown that the humeral site is capable of infusing significantly larger volumes of fluid than the tibial site in a swine model under high infusion pressures (Warren et al, 1993; Lairet et al, 2010, 2011). However, results from human studies comparing the humeral and tibial sites have been mixed.…”

Section: Flow Ratesmentioning

confidence: 99%

Intraosseous vascular access: A review

Paxton

2012

Trauma

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Intraosseous cannulation is an increasingly common means of achieving vascular access for the administration of fluids and medications during the emergent resuscitation of both paediatric and adult patients. Improved tools and techniques for intraosseous vascular access have recently been developed, enabling the healthcare provider to choose from a wide range of devices and insertion sites. Despite its increasing popularity within the adult population, and decades of use in the paediatric population, questions remain regarding the safety and efficacy of intraosseous infusion. Although various potential complications of intraosseous cannulation have been theorized, few serious complications have been reported. This article aims to provide a review of the current literature on intraosseous vascular access, including discussion on the various intraosseous devices currently available in the market, the advantages and disadvantages of intraosseous access compared to conventional vascular access methods, complications of intraosseous cannulation and current recommendations on the use of this approach.

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79: Intraosseous Pressure Infusion Comparison Using a Rapid Infusion Device and a Pressure Bag In a Swine Model

Cited by 7 publications

References 0 publications

Comparison of the Fluid Resuscitation Rate with and without External Pressure Using Two Intraosseous Infusion Systems for Adult Emergencies, the CITRIN (Comparison of InTRaosseous infusion systems in emergency medicINe)-Study

Comparison of the Fluid Resuscitation Rate with and without External Pressure Using Two Intraosseous Infusion Systems for Adult Emergencies, the CITRIN (Comparison of InTRaosseous infusion systems in emergency medicINe)-Study

Safety of Pressurized Intraosseous Blood Infusion Strategies in a Swine Model of Hemorrhagic Shock

Intraosseous vascular access: A review

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