A Pilot Study of Four Intraosseous Blood Transfusion Strategies

J Spec Oper Med. 2018 Fall;18(3):50-56. doi: 10.55460/6SU5-H23M.


Background: Intraosseous (IO) access is used by military first responders administering fluids, blood, and medications. Current IO transfusion strategies include gravity, pressure bags, rapid transfusion devices, and manual push-pull through a three-way stopcock. In a swine model of hemorrhagic shock, we compared flow rates among four different IO blood transfusion strategies.

Methods: Nine Yorkshire swine were placed under general anesthesia. We removed 20 to 25mL/kg of each animal's estimated blood volume using flow of gravity. IO access was obtained in the proximal humerus. We then autologously infused 10 to 15mL/kg of the animal's estimated blood volume through one of four randomly assigned treatment arms.

Results: The average weight of the swine was 77.3kg (interquartile range, 72.7kg-88.8kg). Infusion rates were as follows: gravity, 5mL/min; Belmont rapid infuser, 31mL/min; single-site pressure bag, 78mL/min; double-site pressure bag, 103mL/min; and push-pull technique, 109mL/min. No pulmonary arterial fat emboli were noted.

Conclusion: The optimal IO transfusion strategy for injured Servicemembers appears to be single-site transfusion with a 10mL to 20mL flush of normal saline, followed immediately by transfusion under a pressure bag. Further study, powered to detect differences in flow rate and clinical complications. is required.

MeSH terms

  • Animals
  • Blood Transfusion / instrumentation*
  • Blood Transfusion / methods*
  • Blood Volume
  • Disease Models, Animal
  • Female
  • Gravitation
  • Infusions, Intraosseous / methods
  • Pilot Projects
  • Pressure
  • Random Allocation
  • Shock, Hemorrhagic / therapy*
  • Swine