在损伤控制性复苏中，紧急胸骨骨髓内输血途径用于温热新鲜全血输注。
Emergency sternal intraosseous access for warm fresh whole blood transfusion in damage control resuscitation.
机构信息
From the Department of Anaesthesia and Intensive Care (C.K.B., T.F., A.B.G.), Haukeland University Hospital, Bergen; Norwegian Navy Special Operations Commando (C.K.B., T.F., H.S.E., G.S.); Department of Immunology and Transfusion Medicine (T.O.P., J.S., H.B., H.S.E., G.S.), Haukeland University Hospital, Bergen, Norway; Coagulation and Blood Research (A.P.C.), US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas; Department of War Surgery and Emergency Medicine (G.S.), Norwegian Armed Forces Medical Services, Oslo, Norway. Clinical Institute 1, University of Bergen, Bergen Norway (C.K.B., T.K.F., A.B.G.).
出版信息
J Trauma Acute Care Surg. 2018 Jun;84(6S Suppl 1):S120-S124. doi: 10.1097/TA.0000000000001850.
BACKGROUND
Intraosseous (IO) vascular access is increasingly used as an emergency tool for achieving access to the systemic circulation in critically ill patients. The role of IO transfusion of blood in damage control resuscitation is however questionable due to possible inadequate flow rate and hemolysis. Some experts claim that IO transfusion is contraindicated. In this study, we have challenged this statement by looking at flow rates of autologous fresh whole blood reinfusion and hemolysis using two of the commonly used Food and Drug Administration-approved and Conformité Européenne (CE)-marked sternal needles. Additionally, the success rate of sternal access between the two devices is evaluated.
METHODS
Volunteer professional military personnel, were enrolled prospectively in a nonrandomized observational study design. We collected 450 mL of autologous whole blood from each participant. Participants were divided into the following three groups of 10: Tactically Advanced Lifesaving IO Needle (T.A.L.O.N.) IO, FAST1 IO, and intravenous group. The reinfusion was done by gravity only. Blood sampling was performed before blood collection and 30 minutes after reinfusion. Investigation of hemolysis was performed by measurements of haptoglobin and lactate dehydrogenase. Success rate was evaluated by correct aspiration of bone marrow.
RESULTS
Median reinfusion rate was 46.2 mL/min in the FAST1 group, 32.4 mL/min in the T.A.L.O.N. group, and 74.1 mL/min in the intravenous group. Blood samples from all participants were within normal ranges. There was no statistically significant difference in haptoglobin and lactate dehydrogenase between the groups. In the FAST1 group, 1 (9%) of 11 procedures failed. In the T.A.L.O.N. group, 4 (29%) of 14 procedures failed.
CONCLUSION
Although preferable, achieving peripheral venous access in the bleeding patient is a major problem. Our findings suggest that fresh whole-blood transfusion through the IO route is safe, reliable, and provide sufficient flow for resuscitation.
LEVEL OF EVIDENCE
Therapeutic/Care management study, level III.
背景
骨内（IO）血管通路作为一种在危重病患者中获得全身循环通路的紧急工具，其应用日益增多。然而，由于可能存在流量不足和溶血，IO 输血在损伤控制性复苏中的作用存在争议。一些专家声称 IO 输血是禁忌的。在这项研究中，我们通过观察两种常用的经美国食品和药物管理局批准和符合欧洲标准（CE）标记的胸骨针的自体新鲜全血再灌注的流量和溶血，对这一说法提出了挑战。此外，还评估了两种设备之间胸骨穿刺的成功率。
方法
志愿专业军事人员前瞻性地被纳入非随机观察性研究设计。我们从每位参与者中采集 450 毫升的自体全血。参与者分为以下三组，每组 10 人：战术先进的救生 IO 针（T.A.L.O.N.）IO、FAST1 IO 和静脉组。再灌注仅通过重力进行。在采血前和再灌注后 30 分钟采集血样。通过测量触珠蛋白和乳酸脱氢酶来检测溶血情况。通过正确抽吸骨髓来评估成功率。
结果
FAST1 组的中位再灌注率为 46.2 毫升/分钟，T.A.L.O.N. 组为 32.4 毫升/分钟，静脉组为 74.1 毫升/分钟。所有参与者的血样均在正常范围内。各组间触珠蛋白和乳酸脱氢酶无统计学差异。在 FAST1 组中，11 例中有 1 例（9%）失败。在 T.A.L.O.N. 组中，14 例中有 4 例（29%）失败。
结论
尽管外周静脉通路是理想的选择，但在出血患者中建立外周静脉通路是一个主要问题。我们的研究结果表明，通过 IO 途径进行新鲜全血输注是安全、可靠的，并且可以为复苏提供足够的流量。
证据水平
治疗/护理管理研究，III 级。
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