Resuscitation from hypovolemia in swine with intraosseous infusion of a saturated salt-dextran solution.

Prehospital fluid resuscitation of traumatic injury is limited by difficulty in delivering large volumes of fluid in the field and time delays associated with gaining vascular access. We addressed these limitations in 14 anesthetized swine by evaluating a highly efficient volume expander, a near-saturated salt-dextran solution (SSD) administered through a new device, which gains vascular access via intraosseous (IO) infusion into the sternal bone marrow. After a steady-state baseline was achieved, all animals were hemorrhaged to 45 mm Hg for one hour. Half of the hemorrhaged animals were infused intraosseously with either normal saline (NS) or SSD until cardiac output was restored to the baseline value. No further infusion was given and animals were monitored for 2 hours. Both regimens were able to restore cardiac output to the baseline value, but only 1.3 +/- 0.1 mL/kg of SSD was required vs. 31.6 +/- 6.3 mL/kg for NS. In addition, cardiac output was better sustained after 2 hours with SSD than with NS. No deleterious effects of IO infusion of SSD were observed. From the improvement in cardiovascular variables and the lack of significant sternal or pulmonary pathologic perturbations, these data suggest that IO infusion of SSD can effectively treat hypovolemia and may allow field treatment when logistic considerations make conventional resuscitation impractical.

Resuscitation of hypovolemia in pigs using near saturated sodium chloride solution in dextran.

A 7.5% sodium chloride/6% Dextran solution (HSD) is effective for restoration of cardiovascular function after hemorrhagic shock. In the present experiments, we tested the usefulness and side effects of a 25% NaCl/24% Dextran solution (SSD), compared to HSD and 0.9% NaCl (NS). After 1 hr of baseline observation, 21 anesthetized pigs were submitted to hemorrhagic shock, maintaining a mean arterial pressure of 45 mmHg for 60 min. Continuous intravenous infusion of one of the solutions was then initiated and the infusion rate adjusted to restore and maintain cardiac output at baseline levels for 2 hr. The NS group required 121 +/- 22 ml/kg to achieve full resuscitation, while the HSD and SSD groups required 6.3 +/- 1.3 and 1.7 +/- 0.2 ml/kg, respectively. We conclude that SSD infusions were exceedingly effective at restoring cardiovascular function in volumes equal to only 10% of bled volume, but were associated with transient hemolysis and peripheral vein inflammation.

Comparison of intraosseous and intravenous delivery of hypertonic saline/dextran in anesthetized, euvolemic pigs.

STUDY OBJECTIVES: With renewed interest in intraosseous (IO) infusion, the present study examined if sternal IO infusion provided vascular entry of 7.5% NaCl/6% dextran-70 (HSD) as efficiently as IV infusion. DESIGN, SETTING, TYPE OF PARTICIPANTS, INTERVENTIONS: Twelve anesthetized pigs were catheterized for measurement of cardiovascular parameters. Six pigs were given a 4-mL/kg IO infusion of HSD under pressure over two to six minutes; each pig was paired with another that had been given HSD IV over the same time course. Rapid arterial blood sampling was used to evaluate vascular entry of NaCl and dextran with monitoring continued for two hours after infusion. MEASUREMENTS AND MAIN RESULTS: Complete vascular entry of infused sodium and dextran was generally complete within one minute after infusion in all experiments. Increases in mean arterial pressure, cardiac output, and other cardiovascular parameters were indistinguishable between IO and IV infusions. Plasma volume expansion was about 20% above baseline in both groups of pigs. Histologic examination showed minimum pathology to the sternum and no significant pulmonary complications. CONCLUSION: 1O vascular delivery of HSD is a viable alternative in emergency scenarios in which vascular access is compromised.