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

• Published in: The Journal of surgical research Vol. 246; pp. 190 - 199
• Main Authors: Auten, Jonathan D., McEvoy, Christian S., Roszko, Paul J., Polk, Travis M., Kachur, Ryan E., Kemp, Jean D., Natarajan, Ramesh, Zarow, Greg J.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-02-2020
• Subjects: Adult; Animals; Blood transfusion; Blood Transfusion - methods; Disease Models, Animal; Female; Hemoglobins - analysis; Hemolysis; Hemorrhagic shock; Humans; Humerus; Infusions, Intraosseous - adverse effects; Infusions, Intraosseous - methods; Intraosseous infusion; Intraosseous transfusion; Operational medicine; Pressure - adverse effects; Random Allocation; Resuscitation - adverse effects; Resuscitation - methods; Shock, Hemorrhagic - blood; Shock, Hemorrhagic - therapy; Sus scrofa; Time Factors; Treatment Outcome; Intraosseous transfusion; Intraosseous infusion; Hemorrhagic shock; Blood transfusion; Operational medicine
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2019.09.005

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.
Adult female Yorkshire swine (Sus scrofa; n = 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 = 12 each). Flow rates, infusion pressures, vitals, biochemical variables, and pulmonary and renal tissue pathology were contrasted between groups.
Flow rates were greater for the Push-Pull strategy than Pressure Bag (96.5 mL/min versus 72.6 mL/min, P = 0.02) or Rapid Infuser (96.5 mL/min versus 60 mL/min, P = 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 = 0.02) or Pressure Bag (40 mg/dL versus 12 mg/dL, P = 0.01). Groups did not significantly differ in vitals, biochemical variables, or tissue pathology.
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.