Hypertonic saline: intraosseous infusion causes myonecrosis in a dehydrated swine model of uncontrolled hemorrhagic shock.

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.

• Authors: Hasan B Alam, Corazon M Punzalan, Elena Koustova, Mark W Bowyer, Peter Rhee
• Journal: The Journal of trauma (J Trauma) Vol. 52 Issue 1 Pg. 18-25 (Jan 2002) ISSN: 0022-5282 [Print] United States
• PMID: 11791047 (Publication Type: Journal Article, Research Support, U.S. Gov't, Non-P.H.S.)

Chemical References

• Saline Solution, Hypertonic

Topics

• Animals
• Blood Pressure (physiology)
• Dehydration (complications, drug therapy, physiopathology)
• Disease Models, Animal
• Iliac Artery (injuries, pathology, physiopathology)
• Iliac Vein (injuries, pathology, physiopathology)
• Infusions, Intraosseous
• Muscle, Skeletal (pathology)
• Necrosis
• Saline Solution, Hypertonic (administration & dosage, adverse effects, therapeutic use)
• Shock, Hemorrhagic (complications, drug therapy, physiopathology)
• Survival Analysis
• Swine
• Tibia (pathology)
• Time Factors