Single Versus Double Anatomic Site Intraosseous Blood Transfusion in a Swine Model of Hemorrhagic Shock

Sulava, Eric; Bianchi, William; McEvoy, Christian S.; Roszko, Paul J D; Zarow, Gregory J.; Gaspary, Micah J; Natarajan, Ramesh; Auten, Jonathan D.

doi:10.1016/j.jss.2021.04.035

Cited by 10 publications

(8 citation statements)

References 47 publications

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“…Using a pressure bag significantly increased administration speed, which was not inferior to that of IV access. The infusion flow rates associated with pressure bag use in IO administration are known to range from 30 to 70 mL/min, and our study reflects these results [32][33][34]. Increasing the pressure during blood transfusion can increase the possibility of hemolysis, indicating a need for further research into the safety of blood administration [34][35][36][37].…”

Section: Discussionsupporting

confidence: 61%

“…Furthermore, this study lacks a description of the size, location, and number of IV (peripheral or central) lines to which IO access is compared. Finally, it has been reported that infusion via one anatomical site versus simultaneous infusion via two sites can produce a difference in speed [32]. After excluding patients in the IO group who were also administered IV, a comparison between the IO-only and IV groups should have been performed; however, this was not feasible because of the small number of patients.…”

Section: Discussionmentioning

confidence: 99%

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The Efficacy of Intraosseous Access for Initial Resuscitation in Patients with Severe Trauma: A Retrospective Multicenter Study in South Korea

Kim,

Lee,

Chang

et al. 2024

JCM

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Background/Objective: In patients with severe trauma, intraosseous (IO) access is an alternative when intravenous (IV) access proves challenging. However, detailed insights into its utilization patterns and effectiveness are lacking. This study aims to evaluate the use and efficacy of IO access in hemodynamically unstable patients with trauma at level-1 trauma centers in South Korea. Methods: Data from six centers over 12 months were analyzed, focusing on patients with traumatic cardiac arrest or shock. Overall, 206 patients were included in the study: 94 in the IO group and 112 in the IV group. Results: The first-attempt success rate was higher in the IO group than in the IV group (90.4% vs. 75.5%). The procedure time in the IO group was also shorter than that in the IV group. The fluid infusion rate was lower in the IO group than in the IV group; however, the use of a pressure bag with IO access significantly increased the rate, making it comparable to the IV infusion rate. Further, regarding IO access, a humeral site provided a higher infusion rate than a tibial site. Conclusions: IO access offers a viable alternative to IV access for the initial resuscitation in patients with trauma, providing advantages in terms of procedure time and first-attempt success rate. The use of a pressure bag and a humeral site for IO access afforded infusion rates comparable to those associated with IV access.

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

The Efficacy of Intraosseous Access for Initial Resuscitation in Patients with Severe Trauma: A Retrospective Multicenter Study in South Korea

Kim,

Lee,

Chang

et al. 2024

JCM

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“…Cadaveric swine ( Sus scrofa ) in the 70‒90 kg range were selected because their proximal humerus bone density (>1 g/cm 2 ) approximates that of an average 20‒40‐year‐old male trauma patient. 11 , 26 , 27 , 28 We utilized recently euthanized cadaveric swine samples to foster the “Refine, Reduce, Reuse” principle of animal research 29 , 30 and because cadaveric swine models have demonstrated great utility in previous investigations of IO infusion. 31 , 32 In this translational model, we chose one long bone (proximal humerus) and one non‐load‐bearing bone (sternum) to test the relationship between catheter tip location, flow rates, and infusion pressure.…”

Section: Methodsmentioning

confidence: 99%

“…Despite this limitation, pressure measurements were consistent with infusion parameters from prior in vivo IO studies and allowed for comparative assessments. 11 , 28 , 39 , 40 Furthermore, previous animal studies have demonstrated that IO hydrostatic pressure is proportional to arterial pressure. 41 This is important, because the present study was designed to contrast flow and pressure relative to zones of catheter tip placement, not to acquire absolute flow and pressure values, which somewhat ameliorates the limitations of using a cadaveric model rather than a pressurized in vivo model.…”

Section: Limitationsmentioning

confidence: 98%

“… 11 , 29 , 30 Although swine anatomy does not directly translate to human anatomy, porcine bone was intentionally chosen because it has been shown to be an excellent translational model for transfusion research. 19 , 28 , 31 , 32 While the present cadaveric model lacked the realism of skin and the challenges of identifying appropriate IO sites based on anatomical landmarks, we chose samples from swine with bone density closely approximating a young adult population.…”

Section: Limitationsmentioning

confidence: 99%

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The relationship between intraosseous catheter tip placement, flow rates, and infusion pressures in a high bone density cadaveric swine (Sus scrofa) model

Gehrz,

Kay,

Grady

et al. 2024

JACEP Open

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BackgroundIntraosseous (IO) infusion is a life‐preserving technique when intravenous access is unobtainable. Successful IO infusion requires sufficiently high flow rates to preserve life but at low enough pressures to avoid complications. However, IO catheter tips are often misplaced, and the relative flow rates and pressures between IO catheter tips placed in medullary, trabecular, and cortical bone are not well described, which has important implications for clinical practice.ObjectivesWe developed the Zone Theory of IO Catheter Tip Placement based on bone density and proximity to the venous central sinus and then tested the influence of catheter tip placement locations on flow rates and pressures in a cadaveric swine model.MethodsThree cross‐trained participants infused 500 mL of crystalloid fluid into cadaveric swine humerus and sternum (N = 210 trials total) using a push‒pull method with a 60 cm3 syringe. Computed tomography scans were scored by radiologists and categorized as zone 1 (medullary space), zone 2 (trabecular bone), or zone 3 (cortical bone) catheter tip placements. Differences between zones in flow rates, mean pressures, and peak pressures were assessed using analysis of variance and analysis of covariance to account for participant and site differences at the p < 0.05 threshold.ResultsZone 1 and zone 2 placements were essentially identical in flow rates, mean pressures, and peak pressures (each p > 0.05). Zone 1 and zone 2 placements were significantly higher in flow rates and lower in pressures than zone 3 placements (each p < 0.05 or less).ConclusionWithin the limitations of an unpressurized cadaveric swine model, the present findings suggest that IO catheter tip placements need not be perfect to acquire high flow rates at low pressures, only accurate enough to avoid the dense cortical bone of zone 3. Future research using in vivo animal and human models is needed to better define the clinical impact of IO catheter placement on infusion flow rates and pressures.

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Flow Rates with Intraosseous Catheterization

Righi,

Paxton

2024

Intraosseous Vascular Access

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Single Versus Double Anatomic Site Intraosseous Blood Transfusion in a Swine Model of Hemorrhagic Shock

Cited by 10 publications

References 47 publications

The Efficacy of Intraosseous Access for Initial Resuscitation in Patients with Severe Trauma: A Retrospective Multicenter Study in South Korea

The Efficacy of Intraosseous Access for Initial Resuscitation in Patients with Severe Trauma: A Retrospective Multicenter Study in South Korea

The relationship between intraosseous catheter tip placement, flow rates, and infusion pressures in a high bone density cadaveric swine (Sus scrofa) model

Flow Rates with Intraosseous Catheterization

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