Highlights from #EAST2014 - Comparison of sites for IO placement

Interesting comparison of IO sites.  The catheter with the lowest flow rate ex vivo, showed the highest flow rate when placed in the sternum.  

INTRAOSSEOUS INFUSION RATES UNDER HIGH PRESSURE: A CADAVER STUDY OF ANATOMICAL SITE COMPARISONS

Jason Pasley, DO*, Catriona Miller, PhD, Kimberly Boswell, MD,
Chuck Halcome, NREMT-P, BS, Jonathan Casey, MSN, CRNA, Stacy A. Shackelford, MD*, Raymond Fang, MD, FACS*, Joseph J. DuBose, MD*, Michael Cotter, Associates in Health Sciences, Michael Matsuura, MD, Nathaniel Relph, Julie Bosch, PhD, Nick Tarmey, MBChB FRCA DICM DipIMC R Adams Cowley Shock Trauma Center

Presenter: Jason Pasley, DO
Discussant: Lance Stuke, MD, MPH, Louisiana State University

Objectives: Intraosseous (IO) access for emergency resuscitation is recommended when conventional peripheral vascular access is not readily achievable. The aim of this research is to determine which of three possible sites for IO access is the most effective for volume resuscitation, defined in terms of flow volumes achievable for resuscitation fluids. A cadaver model was used, as to date there have been no conclusive studies in human subjects.

Methods: Sixteen cadavers were obtained within 72 hours of death in collaboration with the Maryland State Anatomy Board from March 15, 2012 to June 21, 2013. IO infusion devices were placed in the proximal tibia (EZ- IO), humeral head (EZ-IO), and sternum (FAST-1). Sequentially, the volume of 0.9% saline infused into each site under 300 mmHg pressure over five minutes was recorded. Mean infused volumes were compared between the three IO sites. Analysis of variance (ANOVA) was used to determine significance (p<0.05).

Results: Analysis of sixteen cadavers (average age 58), Caucasian (14 of 16), and male (13 of 16) found that the mean volume infused at each site was sternum (469 ml), humerus (286 ml), and tibia (154 mls) [F(2,47) = 13.025, p<0.001]. The humeral site had the greatest variability in volumes infused, ranging from 30.0 ml to 730 ml. The tibial site had the greatest number of insertion difficulties.

Conclusions: This is the first study comparing the rate of flow at various IO sites in an adult human model. Our results show that the sternal site for IO access provides the most consistent and highest flow compared to the humeral and tibial insertion sites. The average volume infused in the sternum was 1.6 and 3.1 times greater than the average volume infused in the humeral and tibial sites.