Sternal Intraosseous Devices: Review of the Literature
Jared A Laney1, Jonathan Friedman2, Andrew D Fisher3,4
1Texas A&M University College of Medicine, Bryan, Texas.
Insights
Sternal intraosseous (IO) access is an underutilized but effective vascular access method for adults and older children. It offers advantages in emergencies, especially when rapid infusion or novice IO device use is needed.
Area of Science:
- Emergency Medicine
- Critical Care
- Vascular Access
Background:
- Intraosseous (IO) access is crucial for critically ill patients.
- Proximal humerus and tibia are common IO sites, but sternal IO is often overlooked.
- Sternal IO use has increased due to military conflicts.
Purpose of the Study:
- To review the utility and advantages of sternal intraosseous (IO) vascular access.
- To highlight the underutilization of sternal IO in civilian emergency settings.
Main Methods:
- A literature review was conducted using PubMed and Google Scholar.
- Searched terms included "sternal IO," "sternal intraosseous," and "intraosseous."
- 47 articles were included in the review.
Main Results:
- Sternal IOs are FDA-approved for ages 12+.
- Sternal IO offers anatomical, pharmacokinetic, hemodynamic, and logistical benefits.
- Sternal IO is safe during CPR and provides adequate flow rates for resuscitation.
Conclusions:
- Sternal IO access is underutilized in civilian emergency medicine.
- Consider sternal IO for adults/older children, especially for novices, high flow rates, extremity trauma, or lipid-soluble drugs.
Introduction:
The intraosseous (IO) route is one of the primary means of vascular access in critically ill and injured patients. The most common sites used are the proximal humerus, proximal tibia, and sternum. Sternal IO placement remains an often-overlooked option in emergency and prehospital medicine. Due to the conflicts in Afghanistan and Iraq the use of sternal IOs have increased.
Methods:
The authors conducted a limited review, searching PubMed and Google Scholar databases for "sternal IO," "sternal intraosseous," and "intraosseous" without specific date limitations. A total of 47 articles were included in this review.
Results:
Sternal IOs are currently FDA approved for ages 12 and older. Sternal IO access offers several anatomical, pharmacokinetic, hemodynamic, and logistical advantages over peripheral intravenous and other IO points of access. Sternal IO use carries many of the same risks and limitations as the humeral and tibial sites. Sternal IO gravity flow rates are sufficient for transfusing blood and resuscitation. In addition, studies demonstrated they are safe during active CPR.
Conclusion:
The sternal IO route remains underutilized in civilian settings. When considering IO vascular access in adults or older children, medical providers should consider the sternum as the recommended IO access, particularly if the user is a novice with IO devices, increased flow rates are required, the patient has extremity trauma, or administration of a lipid soluble drug is anticipated.
