Sternal Intraosseous Devices: Review of the Literature

Abstract

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.

Intraosseous access in the resuscitation of patients with trauma: the good, the bad, the future

“…Moreover, the sternum is another common site of IO insertion, particularly in the military setting, as a convenient and efficient site for the infusion of large volumes. 2 This technique is often used in emergency situations, particularly in trauma scenarios, where obtaining intravenous access may be challenging or time-consuming. The use of IOs for patients in clinical cardiac arrest during ongoing cardiopulmonary resuscitation has been endorsed by the American Heart Association and the International Liaison Committee on Resuscitation 3 While IO access is a valuable tool in trauma and emergency medicine, it is important to note that it is typically considered a bridge to more definitive vascular access.…”