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Comparison of Flow Rate, Pressure, and Safety Among Pressurized Intraosseous Blood Transfusion Strategies in a Swine (Sus scrofa) Model of Hemorrhagic Shock


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Three of the top five preventable causes of battlefield death (extremity hemorrhage, junctional hemorrhage, noncompressible torso hemorrhage) rely on rapid vascular access to initiate Advanced Resuscitative Care (ARC). Current Tactical Combat Casualty Care(TCCC) guidelines stress the importance of initiating resuscitation within 30 minutes of wounding. However, the massively hemorrhaged patient, such as dismounted complex blast injuries (DCBI), presents a vascular access challenge to even the most seasoned medical teams. Intraosseous (IO) catheters provide non-collapsible access in patients that can serve as a bridge to therapy while preparations are made for central venous access, when peripheral access is not obtainable. For this reason, IO access has been used extensively over the past decade by military first responders initiating remote damage-controlled resuscitation (rDCR). Despite the clear importance of early vascular access in ARC for blood product transfusion, a knowledge gap exists on which IO blood infusion strategy best balances flow with safety concerns. Wide clinical variability exists with infusion strategies ranging from gravity to manual syringe infusion. Both safety and efficacy concerns have been expressed within the trauma/critical care community that IO gravity infusion cannot meet the demands of rDCR. Concern also exists that infusion pressures above gravity may lead to increased shear stresses causing intravascular hemolysis and/or displacement of marrow into the venous system leading to fat emboli. Filling this knowledge gap by determining which infusion strategy possesses flow rates rapid enough to preserve life but minimize secondary infusion pressure related complications has the long-term impact of improving battlefield survival.



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