TY - JOUR
T1 - Effectiveness of Sternal Intraosseous Device in Patients Presenting with Circulatory Shock A Retrospective Observational Study
AU - Hynes, Allyson M.
AU - Murali, Shyam
AU - Bass, Gary A.
AU - Kheirbek, Tareq
AU - Qasim, Zaffer
AU - George, Naomi
AU - Yelon, Jay A.
AU - Chreiman, Kristen C.
AU - Martin, Niels D.
AU - Cannon, Jeremy W.
N1 - Publisher Copyright:
© 2023, Breakaway Media LLC. All rights reserved.
PY - 2023/12/1
Y1 - 2023/12/1
N2 - Background: Hemorrhagic shock requires timely administration of blood products and resuscitative adjuncts through multiple access sites. Intraosseous (IO) devices offer an alternative to intravenous (IV) access as recommended by the massive hemorrhage, A-airway, R-respiratory, C-circulation, and H-hypothermia (MARCH) algorithm of Tactical Combat Casualty Care (TCCC). However, venous injuries proximal to the site of IO access may complicate resuscitative attempts. Sternal IO access represents an alternative pioneered by military personnel. However, its effectiveness in patients with shock is supported by limited evidence. We conducted a pilot study of two sternal-IO devices to investigate the efficacy of sternal-IO access in civilian trauma care. Methods: A retrospective review (October 2020 to June 2021) involving injured patients receiving either a TALON™ or a FAST1™ sternal-IO device was performed at a large urban quaternary academic medical center. Baseline demographics, injury characteristics, vascular access sites, blood products and medications administered, and outcomes were analyzed. The primary outcome was a successful sternal-IO attempt. Results: Nine males with gunshot wounds transported to the hospital by police were included in this study. Eight patients were pulseless on arrival, and one became pulseless shortly thereafter. Seven (78%) sternal-IO placements were successful, including six TALON devices and one of the three FAST1 devices, as FAST1 placement required attention to Operator positioning following resuscitative thoracotomy. Three patients achieved return of spontaneous circulation, two proceeded to the operating room, but none survived to discharge. Conclusions: Sternal-IO access was successful in nearly 80% of attempts. The indications for sternal-IO placement among civilians require further evaluation compared with IV and extremity IO access.
AB - Background: Hemorrhagic shock requires timely administration of blood products and resuscitative adjuncts through multiple access sites. Intraosseous (IO) devices offer an alternative to intravenous (IV) access as recommended by the massive hemorrhage, A-airway, R-respiratory, C-circulation, and H-hypothermia (MARCH) algorithm of Tactical Combat Casualty Care (TCCC). However, venous injuries proximal to the site of IO access may complicate resuscitative attempts. Sternal IO access represents an alternative pioneered by military personnel. However, its effectiveness in patients with shock is supported by limited evidence. We conducted a pilot study of two sternal-IO devices to investigate the efficacy of sternal-IO access in civilian trauma care. Methods: A retrospective review (October 2020 to June 2021) involving injured patients receiving either a TALON™ or a FAST1™ sternal-IO device was performed at a large urban quaternary academic medical center. Baseline demographics, injury characteristics, vascular access sites, blood products and medications administered, and outcomes were analyzed. The primary outcome was a successful sternal-IO attempt. Results: Nine males with gunshot wounds transported to the hospital by police were included in this study. Eight patients were pulseless on arrival, and one became pulseless shortly thereafter. Seven (78%) sternal-IO placements were successful, including six TALON devices and one of the three FAST1 devices, as FAST1 placement required attention to Operator positioning following resuscitative thoracotomy. Three patients achieved return of spontaneous circulation, two proceeded to the operating room, but none survived to discharge. Conclusions: Sternal-IO access was successful in nearly 80% of attempts. The indications for sternal-IO placement among civilians require further evaluation compared with IV and extremity IO access.
KW - intraosseous
KW - resuscitation
KW - sternal intraosseous
KW - sternal vascular access
KW - sternum
KW - vascular access
UR - http://www.scopus.com/inward/record.url?scp=85181395113&partnerID=8YFLogxK
U2 - 10.55460/AAZW-R052
DO - 10.55460/AAZW-R052
M3 - Article
C2 - 38064650
AN - SCOPUS:85181395113
SN - 1553-9768
VL - 23
SP - 81
EP - 86
JO - Journal of Special Operations Medicine
JF - Journal of Special Operations Medicine
IS - 4
ER -