Hypertonic saline: intraosseous infusion causes myonecrosis in a dehydrated swine model of uncontrolled hemorrhagic shock

J Trauma. 2002 Jan;52(1):18-25. doi: 10.1097/00005373-200201000-00006.


Background: The Institute of Medicine has recommended intraosseous (IO) infusion of 7.5% hypertonic saline (HTS) for combat casualties in shock. We tested the safety and efficacy of this recommendation in a long-term survival model of uncontrolled hemorrhagic shock using dehydrated swine.

Methods: Fourteen dehydrated Yorkshire swine had placement of a 12G needle in the right anterior tibia under isoflurane anesthesia. Uncontrolled hemorrhage was induced via left iliac artery and vein injury. Animals were kept in shock for 2 hours and then resuscitated over 2 hours with 5 mL/kg of 7.5% HTS given either as 10 small boluses (group I, n = 4) or two large boluses (group II, n = 6) to compare the physiologic response and blood loss. Control animals (group III, n = 4) received an equal volume of 0.9% saline IO and additional intravenous saline to equalize the salt load in all groups.

Results: The three groups had similar physiologic responses, with no increase in blood loss following HTS resuscitation. However, between the second and fifth postresuscitation days, the 7.5% HTS resuscitated animals developed soft tissue necrosis or bone marrow necrosis of the right hind leg (group I, 100%; group II, 66.6%; group III, 0%).

Conclusion: HTS resuscitation effectively restored hemodynamic stability in dehydrated swine without increased bleeding from an uncontrolled vascular injury. However, IO infusion of HTS in this model was associated with a very high rate of local complications. Further investigations should be undertaken before IO use of 7.5% HTS in humans.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Animals
  • Blood Pressure / physiology
  • Dehydration / complications*
  • Dehydration / drug therapy*
  • Dehydration / physiopathology
  • Disease Models, Animal
  • Iliac Artery / injuries
  • Iliac Artery / pathology
  • Iliac Artery / physiopathology
  • Iliac Vein / injuries
  • Iliac Vein / pathology
  • Iliac Vein / physiopathology
  • Infusions, Intraosseous
  • Muscle, Skeletal / pathology
  • Necrosis
  • Saline Solution, Hypertonic / administration & dosage*
  • Saline Solution, Hypertonic / adverse effects
  • Saline Solution, Hypertonic / therapeutic use*
  • Shock, Hemorrhagic / complications*
  • Shock, Hemorrhagic / drug therapy*
  • Shock, Hemorrhagic / physiopathology
  • Survival Analysis
  • Swine
  • Tibia / pathology
  • Time Factors


  • Saline Solution, Hypertonic