Hypertonic saline

Intraosseous infusion causes myonecrosis in a dehydrated swine model of uncontrolled hemorrhagic shock

Hasan B. Alam, Corazon M. Punzalan, Elena Koustova, Mark W. Bowyer, Peter M Rhee

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

Background: The Institute of Medicine has recommended intraosseous (IO) infusion of 7.5% hypertonic saline (HTS) for combat casualties in shock. We tested the safety and efficacy of this recommendation in a long-term survival model of uncontrolled hemorrhagic shock using dehydrated swine. Methods: Fourteen dehydrated Yorkshire swine had placement of a 12G needle in the right anterior tibia under isoflurane anesthesia. Uncontrolled hemorrhage was induced via left iliac artery and vein injury. Animals were kept in shock for 2 hours and then resuscitated over 2 hours with 5 mL/kg of 7.5% HTS given either as 10 small boluses (group I, n = 4) or two large boluses (group II, n = 6) to compare the physiologic response and blood loss. Control animals (group III, n = 4) received an equal volume of 0.9% saline IO and additional intravenous saline to equalize the salt load in all groups. Results: The three groups had similar physiologic responses, with no increase in blood loss following HTS resuscitation. However, between the second and fifth postresuscitation days, the 7.5% HTS resuscitated animals developed soft tissue necrosis or bone marrow necrosis of the right hind leg (group I, 100%; group II, 66.6%; group III, 0%). Conclusion: HTS resuscitation effectively restored hemodynamic stability in dehydrated swine without increased bleeding from an uncontrolled vascular injury. However, IO infusion of HTS in this model was associated with a very high rate of local complications. Further investigations should be undertaken before IO use of 7.5% HTS in humans.

Original languageEnglish (US)
Pages (from-to)18-25
Number of pages8
JournalJournal of Trauma
Volume52
Issue number1
StatePublished - 2002
Externally publishedYes

Fingerprint

Intraosseous Infusions
Hemorrhagic Shock
Swine
Resuscitation
Shock
Hemorrhage
Iliac Vein
National Academies of Science, Engineering, and Medicine (U.S.) Health and Medicine Division
Osteonecrosis
Iliac Artery
Vascular System Injuries
Isoflurane
Tibia
Needles
Leg
Necrosis
Anesthesia
Salts
Hemodynamics
Bone Marrow

Keywords

  • Dehydration
  • Hemorrhagic shock
  • Hypertonic saline
  • Iliac injury
  • Intraosseous infusion
  • Myonecrosis
  • Resuscitation
  • Swine
  • Tissue necrosis
  • Uncontrolled hemorrhage

ASJC Scopus subject areas

  • Surgery

Cite this

Hypertonic saline : Intraosseous infusion causes myonecrosis in a dehydrated swine model of uncontrolled hemorrhagic shock. / Alam, Hasan B.; Punzalan, Corazon M.; Koustova, Elena; Bowyer, Mark W.; Rhee, Peter M.

In: Journal of Trauma, Vol. 52, No. 1, 2002, p. 18-25.

Research output: Contribution to journalArticle

Alam, Hasan B. ; Punzalan, Corazon M. ; Koustova, Elena ; Bowyer, Mark W. ; Rhee, Peter M. / Hypertonic saline : Intraosseous infusion causes myonecrosis in a dehydrated swine model of uncontrolled hemorrhagic shock. In: Journal of Trauma. 2002 ; Vol. 52, No. 1. pp. 18-25.
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AU - Koustova, Elena

AU - Bowyer, Mark W.

AU - Rhee, Peter M

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KW - Uncontrolled hemorrhage

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