Sternal Intraosseous Infusion in Adults Lifesaver or Just a Pain in the Chest?

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 EMS sites in Canada and the U.S.

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.