A review of intraosseous vascular access: current status and military application

Austere far-forward battlefield environments present numerous obstacles in providing adequate medical care to the injured solidier. In addition to logistical constraints that limit the volume of isotonic crystalloid fluids available to resuscitate the injured soldier, hypotension, environmental and tactical conditions, and/or the presence of mass casualties can combine to lead to excessive delays in obtaining vascular access. For many years, intraosseous infusion has been a rapid, reliable method of achieving vascular access under emergency conditions in children. Although intraosseous infusion in adults was used extensively in the 1930s and 1940s, and a sternal puncture kit for bone marrow infusions was a common component of emergency medical supplies during World War II, only recently have there been discussions and experimental studies to evaluate intraosseous infusions in adult medical emergencies. With some medical elements of the U.S. military having recently been reissued intraosseous devices, we thought it timely to review the literature on this technique. This review discusses the efficacy and safety of intraosseous infusions of drugs and fluids, including insertion times and flow rates achieved. Although the intent is to evaluate the feasibility of the technique in the injured soldier, literature citations from studies in children, experimental animals, and human cadavers are included to support the statements made and to offer the reader the opportunity to read the original literature.