Double-barrelled Resuscitation: A Feasibility and Simulation Study of Dual-Intraosseous Needles Into a Single Humerus

Injury. 2015 Nov;46(11):2239-42. doi: 10.1016/j.injury.2015.08.029. Epub 2015 Sep 11.


Introduction: Resuscitation can be delayed, or impaired, by insufficient vascular access. This study examines whether dual-intraosseous needles, inserted into a single porcine humerus, can facilitate rapid and concomitant fluid and medication delivery.

Methods: After inserting one- and then two-intraosseous needles into the same porcine humerus, we determined the rate of fluid administration using (i) an infusion pump set to 999mL/h, and (ii) a standard pressure-bag set to 300mmHg. Next, we concomitantly infused blood, crystalloid and medications into the same medullary canal, using the two-needle set-up. Humeri were inspected for fluid-leakage, needle-displacement, and bone damage.

Results: Using an infusion pump, the mean normal-saline infusion-rate was significantly higher with dual-intraosseous needles compared to a single-intraosseous needle: the infusion-rate was 16mL/min using dual-needles versus 8mL/min for a single needle set-up (p<0.001). In contrast, using the pneumatic pressure-bag, the infusion rate was not statistically different when comparing dual-intraosseous needles versus single-intraosseous: the infusion-rate was 22mL/min versus 21ml/min (p=0.4) for 500mL, and 22ml/min versus 21ml/min (p=0.64) for one-litre, respectively. Blood product could be infused at a mean rate of 20mL/min through one needle while tranexamic acid was simultaneously infused through a second. There were no complications with a dual-intraosseous set-up (no fluid leakage; no needle-displacement; no high-pressure alarms, and no external bone-fractures or internal macrohistological damage) during any of our simulated resuscitation scenarios.

Conclusions: This is the first published study evaluating dual-intraosseous needles in a single bone. Despite limitations, this preliminary study (using a porcine humerus) suggests that dual-intraosseous needles are feasible. For critically-ill patients with limited insertion sites, dual-intraosseous (a.k.a. 'double-barrelled resuscitation') may facilitate rapid and concurrent resuscitation.

Keywords: Fluid administration; Intraosseous; Polytrauma; Resuscitation; Vascular access.

Publication types

  • Evaluation Study

MeSH terms

  • Animals
  • Crystalloid Solutions
  • Feasibility Studies
  • Fluid Therapy / instrumentation
  • Fluid Therapy / methods*
  • Humerus / pathology*
  • Infusions, Intraosseous / methods*
  • Isotonic Solutions / administration & dosage*
  • Male
  • Resuscitation / instrumentation
  • Resuscitation / methods*
  • Swine


  • Crystalloid Solutions
  • Isotonic Solutions