Tibial intraosseous (IO) infusion
is used successfully in resuscitation of critically ill children but
is considered less effective in adults. The sternum may be a better
site in adults because it is large and flat, contains a high
proportion of vascular red marrow, is less likely to be fractured,
and is closer to the central circulation. In this study, a new
system of IO infusion into the adult sternum, called the First
Access for Shock and Trauma (F.A.S.T.) 1, was evaluated in 50
consecutive patients aged 14 to 84 years at 6 EDs
and 5
With F.A.S.T. 1, a handheld introducer is
used to insert a flexible infusion tube with a stainless-steel tip
to a predetermined depth in the sternal manubrium. Fluids and drugs are administered through
the tube into the marrow space. Vascular access was achieved in 84%
of patients. Failure was most common in obese patients (5 of 9).
Mean access time was 77 seconds (range, 30 to 300). Flow rates were
more than 150 ml/min by syringe bolus. Early complications included
localized bleeding, bruising, swelling, redness, and tenderness. In
12 cases, the operators had difficulty using the removal tool. No
complications were reported at 2-month follow-up for the 11
survivors.
Comment: This intriguing study offers clinicians another tool
for emergency resuscitation. Although small and descriptive, the
study suggests that IO sternal infusion is a
reasonable option for adults in extremis with no IV access. The
manufacturer provided equipment and training support for the study.
— KL Koenig
Published in Journal Watch Emergency Medicine June 1, 2000
Source
Macnab A et al. A new system for sternal intraosseous infusion in adults. Prehosp
Emerg Care 2000 Apr/Jun 4 173-177.