Intraosseous infusion rates under high pressure

Abstract

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.

Comparison of the Fluid Resuscitation Rate with and without External Pressure Using Two Intraosseous Infusion Systems for Adult Emergencies, the CITRIN (Comparison of InTRaosseous infusion systems in emergency medicINe)-Study

“…As a consequence, in an emergency situation, the flow rates might be much lower than one may expect on the basis of the mean values. Therefore, our results cannot confirm the findings of Pasley et al [ 20 ], stating that the flow rates of sternal puncture are highly consistent in a 5-minute timeframe. To our surprise, no correlations of the flow rates could be found with the donors’ morphometrics, further indicating that achievable flow rates might be hard to predict.…”

“…In our experiments with unfixed body donors, similar flow rates were observed as recently found in clinical [ 8 ] and experimental studies [ 20 ]. Comparison of the flow rates and cumulative volumes of the unfixed to ethanol-fixed donors revealed different flow rates but similar relative standard deviations, indicating that the ethanol-fixed donors are a valid model to investigate intraosseous devices in a safe environment for inexperienced performers.…”

“…The given flow rates and cumulative volumes were similar to the data of Pasley et al [ 20 ], who applied the FAST1 system (PYNG Medical, Canada), the EZ-IO humerus and EZ-IO tibia to soft-embalmed donors. Significant differences between the EZ-IO humerus and tibia were previously found clinically [ 21 ] and experimentally in human donors [ 20 ] and porcine models [ 11 ]. These differences could not be substantiated by our experiments nor with data of another recent clinical-prospective study [ 8 ].…”

“…This might have partially been related to altered flow characteristics due to the fixatives, thrombosed bone marrow and vessels. To overcome this issue, we determined flow rates in unfixed donors and used these data to normalize the values of the fixed ones, in line with previous studies on intraosseous devices in patients [ 7 , 8 ] as well as in fixed body donors [ 20 ]. Being well aware that these normalizing values are estimation, the use of fixed body donors remains a limitation of the study in addition to post-mortem changes of the vascular system.…”

Bent Metal in a Bone: A Rare Complication of an Emergent Procedure or a Deficiency in Skill Set?

“…On the other hand, while the aforementioned study found no difference in infusion rates, a cadaveric study by Pasley et al found advantages to humeral placement to include capability for faster infusion rates and possible decreased time to central circulation. Flow rate in the humerus was found to be greater than in the tibia, with average flow rate of 57.1 mL/min at the humerus and average flow rate of 30.7 mL/min at the proximal tibia [18]. These findings are consistent with previous trials in swine models [19, 20].…”