Joseph Antony Tyler1, Zane Perkins2, Henry Dudley De'Ath2. 1. Department of Anaesthetics, Russells Hall Hospital, Pensnett Road, Dudley, DY1 2HQ, UK. joseph.tyler@nhs.net. 2. Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK.
Abstract
PURPOSE: Intraosseous (IO) catheters continue to be recommended in trauma resuscitation. Their utility has recently been debated due to concerns regarding inadequate flow rates during blood transfusion, and the potential for haemolysis. The objective of this review was to examine the evidence for intraosseous catheters in trauma resuscitation, and to highlight areas for future research. METHODS: A PubMed and Embase search for articles published from January 1990 to August 2018 using the terms ("intra-osseous access" or "intraosseous access" or "IO access") AND trauma was performed. Original articles describing the use of an IO catheter in the resuscitation of one or more trauma patients were eligible. Animal, cadaveric studies and those involving healthy volunteers were excluded. RESULTS: Nine studies, comprising of 1218 trauma patients and 1432 device insertions, were included. The insertion success rate was 95% and the incidence of complications 0.9%. Flow-rate data and evidence of haemolysis were poorly reported. CONCLUSION: Intraosseous catheters have high insertion success rates and a low incidence of complications in trauma patients. Existing evidence suggests that IO transfusion is not associated with haemolysis, however, further studies in humans are needed. There is a paucity of flow rate data for blood transfusion via IO catheters in this population, although much anecdotal evidence advocating their use exists.
PURPOSE: Intraosseous (IO) catheters continue to be recommended in trauma resuscitation. Their utility has recently been debated due to concerns regarding inadequate flow rates during blood transfusion, and the potential for haemolysis. The objective of this review was to examine the evidence for intraosseous catheters in trauma resuscitation, and to highlight areas for future research. METHODS: A PubMed and Embase search for articles published from January 1990 to August 2018 using the terms ("intra-osseous access" or "intraosseous access" or "IO access") AND trauma was performed. Original articles describing the use of an IO catheter in the resuscitation of one or more traumapatients were eligible. Animal, cadaveric studies and those involving healthy volunteers were excluded. RESULTS: Nine studies, comprising of 1218 traumapatients and 1432 device insertions, were included. The insertion success rate was 95% and the incidence of complications 0.9%. Flow-rate data and evidence of haemolysis were poorly reported. CONCLUSION: Intraosseous catheters have high insertion success rates and a low incidence of complications in traumapatients. Existing evidence suggests that IO transfusion is not associated with haemolysis, however, further studies in humans are needed. There is a paucity of flow rate data for blood transfusion via IO catheters in this population, although much anecdotal evidence advocating their use exists.
Authors: Jeremy W Cannon; Mansoor A Khan; Ali S Raja; Mitchell J Cohen; John J Como; Bryan A Cotton; Joseph J Dubose; Erin E Fox; Kenji Inaba; Carlos J Rodriguez; John B Holcomb; Juan C Duchesne Journal: J Trauma Acute Care Surg Date: 2017-03 Impact factor: 3.313
Authors: John B Holcomb; Charles E Wade; Joel E Michalek; Gary B Chisholm; Lee Ann Zarzabal; Martin A Schreiber; Ernest A Gonzalez; Gregory J Pomper; Jeremy G Perkins; Phillip C Spinella; Kari L Williams; Myung S Park Journal: Ann Surg Date: 2008-09 Impact factor: 12.969
Authors: John B Holcomb; Deborah J del Junco; Erin E Fox; Charles E Wade; Mitchell J Cohen; Martin A Schreiber; Louis H Alarcon; Yu Bai; Karen J Brasel; Eileen M Bulger; Bryan A Cotton; Nena Matijevic; Peter Muskat; John G Myers; Herb A Phelan; Christopher E White; Jiajie Zhang; Mohammad H Rahbar Journal: JAMA Surg Date: 2013-02 Impact factor: 14.766