Sternal Intraosseous Transfusion of Autologous Whole Blood: A Comparison of Flow Rates and Degree of Hemolysis
Condition: Hypovolemic Shock; Hemorrhagic Shock
MeSH terms: Shock; Hemolysis; Shock, Hemorrhagic; Hypovolemia
Study type: Observational

Summary: 
      In this study the impact of two CE marked and FDA approved sternal needles in comparison to
      intravenous access on the flow-rate of autologous reinfusion of whole blood and the possible
      hemolysis of red cells post-transfusion in a population of healthy military officers is
      investigated.
    

Detailed description: 
      Intraosseous (IO) access is an old technique for achieving entrance to the systemic
      circulation, which has gained resurgence in the last 30 years.

      Whether due to trauma or disease, vascular collapse may delay or preclude even experienced
      medical providers from obtaining standard intravenous (IV) access. Access to the vascular
      system of the critically ill or injured adult or pediatric patient is essential for
      resuscitation, and flow rates close up to what can be obtained by using intravenous access is
      preferable in patient needing immediate fluid boluses for shock resuscitation. Intraosseous
      access takes advantage of the vascularity of cancellous bone, the spongy bone inside the
      hard, and access to the highly vascular intramedullary space of bones provides a direct link
      to central circulation. In addition to using long bones, the sternum is used for intraosseous
      access and has gained increased use especially in combat casualty care.

      However, in a recent publication, the intraosseous route used for transfusion of blood
      components is questioned. Based on theoretical models for flow rates through porous media and
      personal clinical observations the authors conclude that the maximum flow rates attainable
      for transfusion of blood via intraosseous route are inadequate for successful resuscitation.
      They also fear that additional pressure needed to obtain adequate flow rate may cause
      hemolysis of red blood cells. Further they postulate that as the bone mineral density reaches
      a peak occurring in the early 20s, and that a small increase in bone density may cause
      exponential decrease in intrinsic permeability, there could be a 10-fold decrease in
      permeability in military age causalities compared to the elderly. The critical points
      highlighted in this review are in great contrast to recent experience with the use of sternal
      and humeral I.O's in Operation Enduring Freedom (OEF).

      This observational study investigates the impact of two CE marked and FDA approved sternal
      needles in comparison to intravenous access on the flow-rate of autologous reinfusion of
      whole blood and the possible hemolysis of red cells post-transfusion in a population of
      healthy military officers. We also investigate the technical success rate of sternal IO
      Access between two CE marked and FDA approved sternal Devices. As a supplementary
      investigation we seek to investigate the anatomic changes as shown by Magnetic Resonance
      Imaging in individuals who have received multiple intraosseous sternal needles With
      autologous reinfusion of whole blood.
    

Intervention name(s): Reinfusion - Sternal IO needle; Reinfusion - Intravenous needle
Intervention type(s): Device; Device
Observational model: Case-Control
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Healthy military officers
      
Keywords: Intraosseous access