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Intraosseous infusion rates under high pressure: a cadaveric comparison of anatomic sites
Jason Pasley1, Catriona H T Miller, Joseph J DuBose
1From the R Adams Cowley Shock Trauma Center (J.P., C.H.T.M., S.A.S., R.F., K.B., C.H., J.C., M.C., M.M., N.R., D.M.S.), University of Maryland Medical Center; and US Air Force Center for Sustainment of Trauma and Readiness Skills (J.P., C.H.T.M., S.A.S., R.F., C.H., J.C., M.C., M.M., N.R.), Baltimore, Maryland; Texas Trauma Institute University of Texas at Houston (J.J.D.), Houston, Texas; and Department of Critical Care (N.T.T.), Ministry of Defence Hospital Unit, Portsmouth, United Kingdom.
Insights
The sternal intraosseous (IO) access site offers the highest and most consistent fluid flow rate compared to humeral and tibial sites, proving superior for emergency vascular access.
Area of Science:
- Emergency Medicine
- Anatomy
- Medical Devices
Background:
- Intraosseous (IO) access is a critical lifesaving technique when traditional vascular access fails.
- IO devices allow for the delivery of fluids, medications, and blood products.
- Comparing performance across different IO insertion sites is crucial for optimizing emergency care.
Purpose of the Study:
- To compare the fluid infusion performance of intraosseous (IO) devices in the sternum, humeral head, and proximal tibia.
- To evaluate flow rates and insertion success in a human cadaver model.
Main Methods:
- Commercially available IO devices (FAST-1, EZ-IO) were placed in the sternum, humeral head, and proximal tibia of fresh human cadavers.
- 0.9% saline infusion volume was measured under pressure (300 mm Hg) over 5 minutes.
- Rates of successful placement and subjective observations were recorded.
Main Results:
- The sternal site demonstrated the highest mean flow rate (93.7 mL/min), followed by the humerus (57.1 mL/min) and tibia (30.7 mL/min).
- The sternal site delivered a significantly greater volume of fluid compared to the other two sites.
- The tibial site presented the most insertion difficulties.
Conclusions:
- The sternal IO access site provides superior and more consistent flow rates compared to humeral and tibial sites in adult cadavers.
- Sternal IO access is a highly effective option for rapid fluid resuscitation in emergencies.
- This study highlights the sternum as a preferred site for adult intraosseous infusions.
Background:
When traditional vascular access methods fail, emergency access through the intraosseous (IO) route can be lifesaving. Fluids, medications, and blood components have all been delivered through these devices. We sought to compare the performance of IO devices placed in the sternum, humeral head, and proximal tibia using a fresh human cadaver model.
Methods:
Commercially available IO infusion devices were placed into fresh human cadavers: sternum (FAST-1), humeral head (EZ-IO), and proximal tibia (EZ-IO). Sequentially, the volume of 0.9% saline infused into each site under 300 mm Hg pressure over 5 minutes was measured. Rates of successful initial IO device placement and subjective observations related to the devices were also recorded.
Results:
For 16 cadavers over a 5-minute bolus infusion, the total volume of fluid infused at the three IO access sites was 469 (190) mL for the sternum, 286 (218) mL for the humerus, and 154 (94) mL for the tibia. Thus, the mean (SD) flow rate infused at each site was as follows: (1) sternum, 93.7 (37.9) mL/min; (2) humerus, 57.1 (43.5) mL/min; and (3) tibia, 30.7 (18.7) mL/min. The tibial site had the greatest number of insertion difficulties.
Conclusion:
This is the first study comparing the rate of flow at the three most clinically used adult IO infusion sites in an adult human cadaver model. Our results showed that the sternal site for IO access provided the most consistent and highest flow rate compared with the humeral and tibial insertion sites. The average flow rate in the sternum was 1.6 times greater than in the humerus and 3.1 times greater than in the tibia.
