L'intraosseuse: Pas adaptée au dammage control resuscitation?

What is the evidence of utility for intraosseous blood transfusion in damage-control resuscitation ?

Harris M et all. J Trauma Acute Care Surg. 2013 Nov;75(5):904-6

 « The scientific and clinical evidence for the use of IO access is voluminous, as evidenced by the Scientific Bibliography provided by VidaCare,6  one of the large manufacturers of IO devices, and available in any routine literature search. However direct scientific and/or clinical data to support the use of IO access for the purpose of blood transfusion in adult humans are very limited to anecdotal reports.

the absence of good evidence supporting the use of IO access for the very critical function of blood transfusion in DCR places existing recommendations for its use in question. This lack of evidence is compounded by the clinical experience of the lead author. Multiple attempts to use IO access for blood transfusion, both in the civilian adult emergency setting and in combat casualty care, have repeatedly been unsuccessful »

1.  La densité osseuse dépend de l'âge

2.  La porosité osseuse dépend de la densité osseuse

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3.  La perméabilité osseuse dépend de la porosité

 

«  The bone mineral density increases with age up to a peak density occurring in the early 20s. The soldier population is aged right at the peak of bone density for all races and sex.

the viscosity of pRBCs used in DCR is estimated to be greater than 10 cP.12  Since pRBCs are 10+ times more viscous than crystalloid solutions, it will require at least 10+ times the pressure to obtain the same flow rate as crystalloid in IO infusion.

Based on the Darcy’s Law, the only parameter a medical practitioner has to adjust to increase flow rate in an IO system in DCR is pressure. Increases in pressure not only strain the connections in the infusion system itself but also increase shearing forces in the fluid. Shearing forces may cause hemolysis of the transfused blood, loss of oxygen carrying capacity, and consequent development of rhabdomyolysis

we postulate that maximum flow rates attainable for transfusion of blood products used in DCR via the IO route are simply inadequate for successful resuscitation »