Intraosseous access in the resuscitation of trauma patients: a literature review

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.

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Authors

Contributions

JAT and HDD conceived the idea for the article. The literature was reviewed and analysed by JAT. The manuscript was drafted by JT and critically revised for intellectual content by ZP and HDD. JAT takes responsibility for the integrity of the data and the accuracy of its analysis.

Corresponding author

Correspondence to Joseph Antony Tyler.

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JAT, ZP and HDD declare that they have no conflict of interest.

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Tyler, J.A., Perkins, Z. & De’Ath, H.D. Intraosseous access in the resuscitation of trauma patients: a literature review. Eur J Trauma Emerg Surg 47, 47–55 (2021). https://doi.org/10.1007/s00068-020-01327-y

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Keywords

  • Intraosseous
  • Resuscitation
  • Trauma
  • Transfusion
  • Flow
  • Haemolysis