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A Comparison of the Effects of Intraosseous and Intravenous 5% Albumin on Infusion Time and Hemodynamic Measures in a Swine Model of Hemorrhagic Shock

Published online by Cambridge University Press:  23 May 2016

Stacy L. Muir ,
Lance B. Sheppard ,
Anne Maika-Wilson ,
James M. Burgert Open the ORCID record for James M. Burgert [Opens in a new window] ,
Jose Garcia-Blanco ,
Arthur D. Johnson  and
Jennifer L. Coyner
Stacy L. Muir
Affiliation:
United States Army Medical Department Center and School, Northeastern University, US Army Graduate Program in Anesthesia Nursing, Fort Sam Houston, Texas USA
Lance B. Sheppard
Affiliation:
United States Army Medical Department Center and School, Northeastern University, US Army Graduate Program in Anesthesia Nursing, Fort Sam Houston, Texas USA
Anne Maika-Wilson
Affiliation:
United States Army Medical Department Center and School, Northeastern University, US Army Graduate Program in Anesthesia Nursing, Fort Sam Houston, Texas USA
James M. Burgert*
Affiliation:
United States Army Medical Department Center and School, Northeastern University, US Army Graduate Program in Anesthesia Nursing, Fort Sam Houston, Texas USA The Geneva Foundation, Tacoma, Washington USA
Jose Garcia-Blanco
Affiliation:
The Geneva Foundation, Tacoma, Washington USA
Arthur D. Johnson
Affiliation:
United States Army Medical Department Center and School, Northeastern University, US Army Graduate Program in Anesthesia Nursing, Fort Sam Houston, Texas USA The Geneva Foundation, Tacoma, Washington USA
Jennifer L. Coyner
Affiliation:
United States Army Medical Department Center and School, Northeastern University, US Army Graduate Program in Anesthesia Nursing, Fort Sam Houston, Texas USA
*
Correspondence: James M. Burgert, DNAP US Army Medical Department and School Northeastern University US Army Graduate Program in Anesthesia Nursing 3490 Forage Rd. Suite 112 Fort Sam Houston, Texas 78234 USA E-mail: james.burgert@alumni.bcm.edu
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Abstract

Introduction

Obtaining intravenous (IV) access in patients in hemorrhagic shock is often difficult and prolonged. Failed IV attempts delay life-saving treatment. Intraosseous (IO) access may often be obtained faster than IV access. Albumin (5%) is an option for prehospital volume expansion because of the absence of interference with coagulation and platelet function.

Hypothesis/Problem

There are limited data comparing the performance of IO and IV administered 5% albumin. The aims of this study were to compare the effects of tibial IO (TIO) and IV administration of 500 mL of 5% albumin on infusion time and hemodynamic measurements of heart rate (HR), mean arterial pressure (MAP), cardiac output (CO), and stroke volume (SV) in a swine model of hemorrhagic shock.

Methods

Sixteen male swine were divided into two groups: TIO and IV. All subjects were anesthetized and a Class III hemorrhage was achieved by exsanguination of 31% of estimated blood volume (EBV) from a femoral artery catheter. Following exsanguination, 500 mL of 5% albumin was administered under pressurized infusion (300 mmHg) by the TIO or IV route and infusion time was recorded. Hemodynamic measurements of HR, MAP, CO, and SV were collected before and after exsanguination and every 20 seconds for 180 seconds during 5% albumin infusion.

Results

An independent t-test determined that IV 5% albumin infusion was significantly faster compared to IO (P=.01). Mean infusion time for TIO was seven minutes 35 seconds (SD=two minutes 44 seconds) compared to four minutes 32 seconds (SD=one minute 08 seconds) in the IV group. Multivariate Analysis of Variance was performed on hemodynamic data collected during the 5% albumin infusion. Analyses indicated there were no significant differences between the TIO and IV groups relative to MAP, CO, HR, or SV (P>.05).

Conclusion

While significantly longer to infuse 5% albumin by the TIO route, the longer TIO infusion time may be negated as IO devices can be placed more quickly compared to repeated IV attempts. The lack of significant difference between the TIO and IV routes relative to hemodynamic measures indicate the TIO route is a viable route for the infusion of 5% albumin in a swine model of Class III hemorrhage.

MuirSL , SheppardLB , Maika-WilsonA , BurgertJM , Garcia-BlancoJ , JohnsonAD , CoynerJL . A Comparison of the Effects of Intraosseous and Intravenous 5% Albumin on Infusion Time and Hemodynamic Measures in a Swine Model of Hemorrhagic Shock. Prehosp Disaster Med.2016;31(4):436–442.

Keywords

albuminhemorrhagic shockinfusion timeintraosseousresuscitation
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 31 , Issue 4 , August 2016 , pp. 436 - 442
Copyright
© World Association for Disaster and Emergency Medicine 2016 

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References

1. Anson, JA. Vascular access in resuscitation: is there a role for the intraosseous route? Anesthesiology. 2014;120(4):1015-1031.CrossRefGoogle Scholar
2. Deakin, CD, Nolan, JP, Soar, J, et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 4. Adult Advanced Life Support. Resuscitation. 2010;81(10):1305-1352.CrossRefGoogle ScholarPubMed
3. Neumar, RW, Otto, CW, Link, MS, et al. Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(18 Suppl 3):S729-S767.Google Scholar
4. Advanced Trauma Life Support (ATLS(R)): the ninth edition. J Trauma Acute Care Surg. 2013;74(5):1363-1366.Google Scholar
5. Laroche, M. Intraosseous circulation from physiology to disease. Joint Bone Spine. 2002;69(3):262-269.Google Scholar
6. Lewis, P, Wright, C. Saving the critically injured trauma patient: a retrospective analysis of 1000 uses of intraosseous access. Emerg Med J. 2015;32(6):463-467.Google Scholar
7. Vassallo, J, Horne, S, Smith, JE. Intraosseous access in the military operational setting. J R Nav Med Serv. 2014;100(1):34-37.CrossRefGoogle ScholarPubMed
8. Santos, D, Carron, PN, Yersin, B, et al. EZ-IO intraosseous device implementation in a pre-hospital emergency service: a prospective study and review of the literature. Resuscitation. 2013;84(4):440-445.CrossRefGoogle Scholar
9. Leidel, BA, Kirchhoff, C, Bogner, V, et al. Comparison of intraosseous versus central venous vascular access in adults under resuscitation in the emergency department with inaccessible peripheral veins. Resuscitation. 2012;83(1):40-45.CrossRefGoogle ScholarPubMed
10. Lairet, JR, Bebarta, V, Mathis, D, et al. 208 comparison of intraosseous infusion rates of blood under high pressure in an adult hypovolemic swine model in three different limb sites. Ann Emerg Med. 2012;60(4, Supplement):S75.Google Scholar
11. Johnson, D, Dial, J, Ard, J, et al. Effects of intraosseous and intravenous administration of hextend(R) on time of administration and hemodynamics in a Swine model. J Spec Oper Med. 2014;14(1):79-85.CrossRefGoogle Scholar
12. Burgert, J, Mozer, J, Williams, T, et al. The effects of intraosseous transfusion of whole blood on hemolysis and transfusion time in a swine model of hemorrhagic shock. AANA J. 2014;82(3):198-202.Google Scholar
13. Hoskins, SL, do Nascimento, P Jr., Lima, RM, et al. Pharmacokinetics of intraosseous and central venous drug delivery during cardiopulmonary resuscitation. Resuscitation. 2012;83(1):107-112.Google Scholar
14. Kheirabadi, BS, Crissey, JM, Deguzman, R, et al. Effects of synthetic versus natural colloid resuscitation on inducing dilutional coagulopathy and increasing hemorrhage in rabbits. J Trauma. 2008;64(5):1218-1228; discussion 1228-1219.Google Scholar
15. Kheirabadi, BS, Valdez-Delgado, KK, Terrazas, IB, et al. Is limited prehospital resuscitation with plasma more beneficial than using a synthetic colloid? An experimental study in rabbits with parenchymal bleeding. J Trauma Acute Care Surg. 2015;78(4):752-759.CrossRefGoogle ScholarPubMed
16. Blebea, JS, Houseni, M, Torigian, DA, et al. Structural and functional imaging of normal bone marrow and evaluation of its age-related changes. Semin Nucl Med. 2007;37(3):185-194.Google Scholar
17. Paquette, S, Gordon, C, Bradtmiller, B. Anthropometric Survey (ANSUR) II Pilot Study: Methods and Summary Statistics. Natick, Massachusetts USA: US Army Natick Soldier Research, Development and Engineering Center; 2009: 74-75.Google Scholar
18. National Research Committee, Committee for the Update of the Guide for the Care and Use of Laboratory Animals, Institute for Laboratory Animal Research, et al. Guide for the Care and Use of Laboratory Animals. Washington, DC USA: National Academies Press; 2011.Google Scholar
19. Kauvar, DS, Lefering, R, Wade, CE. Impact of hemorrhage on trauma outcome: an overview of epidemiology, clinical presentations, and therapeutic considerations. J Trauma. 2006;60(6 Suppl):S3-11.Google Scholar
20. Dubick, MA. Current concepts in fluid resuscitation for prehospital care of combat casualties. US Army Med Dep J. 2011: 18-24.Google Scholar
21. Schafer, N, Driessen, A, Frohlich, M, et al. Diversity in clinical management and protocols for the treatment of major bleeding trauma patients across European Level I Trauma Centers. Scand J Trauma Resusc Emerg Med. 2015;23(1):74.Google Scholar
22. Society IAR. Poiseuille’s Law: IV fluids. http://www.openanesthesia.org/ poiseuilles_law_iv_fluids/. Published 2013. Accessed October 8, 2015.Google Scholar
23. Swindle, MM, Makin, A, Herron, AJ, et al. Swine as models in biomedical research and toxicology testing. Vet Pathol. 2012;49(2):344-356.Google Scholar
24. Butler, FK, Holcomb, JB, Schreiber, MA, et al. Fluid resuscitation for hemorrhagic shock in Tactical Combat Casualty Care: TCCC Guidelines Change 14-01 - 2 June 2014. J Spec Oper Med. 2014;14(3):13-38.Google Scholar
25. Mutter, TC, Ruth, CA, Dart, AB. Hydroxyethyl starch (HES) versus other fluid therapies: effects on kidney function. Cochrane Database Syst Rev. 2013;7:Cd007594.Google Scholar
26. Martini, WZ, Dubick, MA, Blackbourne, LH. Comparisons of lactated Ringer’s and Hextend resuscitation on hemodynamics and coagulation following femur injury and severe hemorrhage in pigs. J Trauma Acute Care Surg. 2013;74(3):732-739; discussion 739-740.CrossRefGoogle ScholarPubMed
27. Cooper, DJ, Myburgh, J, Heritier, S, et al. Albumin resuscitation for traumatic brain injury: is intracranial hypertension the cause of increased mortality? J Neurotrauma. 2013;30(7):512-518.Google Scholar
28. Martinaud, C, Ausset, S, Deshayes, AV, et al. Use of freeze-dried plasma in French intensive care unit in Afghanistan. J Trauma. 2011;71(6):1761-1764; discussion 1764-1765.Google Scholar
29. Sunde, GA, Vikenes, B, Strandenes, G, et al. Freeze dried plasma and fresh red blood cells for civilian prehospital hemorrhagic shock resuscitation. J Trauma Acute Care Surg. 2015;78(6 Suppl 1):S26-S30.Google Scholar