title: Recovery of fibrinogen concentrate after intraosseous application is equivalent to the intravenous route in a porcine model of hemodilution.
abstract: BACKGROUND
  Fibrinogen concentrate is increasingly considered as a hemostatic agent for trauma patients experiencing bleeding. Placing a venous access is sometimes challenging during severe hemorrhage. Intraosseous access may be considered instead. Studies of intraosseous infusion of coagulation factor concentrates are limited. We investigated in vivo recovery following intraosseous administration of fibrinogen concentrate and compared the results with intravenous administration.
  
  
  METHODS
  This study was performed on 12 pigs (mean [SD] body weight, 34.1 [2.8] kg). Following controlled blood loss (35 mL/kg) and fluid replacement with balanced crystalloid solution, intraosseous (n = 6) administration of fibrinogen concentrate (80 mg per kilogram of bodyweight) in the proximal tibia was compared with intravenous (n = 6) administration of the same dose (fibrinogen infusion time approximately 5 minutes in both groups). The following laboratory parameters were assessed: blood cell count, prothrombin time index, activated partial thromboplastin time, and plasma fibrinogen concentration (Clauss assay). Coagulation status was also assessed by thromboelastometry.
  
  
  RESULTS
  All tested laboratory parameters were comparable between the intraosseous and intravenous groups at baseline, hemodilution, and 30 minutes after fibrinogen concentrate administration. In vivo recovery of fibrinogen was also similar in the two groups (89% [23%] and 91% [22%], respectively). There were no significant between-group differences in any of the thromboelastometric parameters. Histologic examination indicated no adverse effects on the tissue surrounding the intraosseous administration site.
  
  
  CONCLUSIONS
  This study suggests that intraosseous administration of fibrinogen concentrate results in a recovery of fibrinogen similar to that of intravenous administration. The intraosseous route of fibrinogen concentrate could be a valuable alternative in situations where intravenous access is not feasible or would be time consuming.
  
  
  METHODS
  Prospective, randomized, therapeutic feasibility study in an animal model, level V.
authors.affiliation: From the Ludwig Boltzmann Institute for Experimental and Clinical Traumatology (C.J.S., C.S., C.K., J.Z., W.O., H.R., H.S.), AUVA Research Centre, Vienna; and Bernhard Gottlieb University of Dentistry (S.N.), Vienna; and Department of Traumatology (S.N.), Medical University of Vienna; and AUVA Trauma Hospital of Salzburg (H.S.), Academic Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria; and CSL Behring (C.S.), Marburg, Germany.
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Schlimp
authors.forename: Cristina
authors.initials: C
authors.lastname: Solomon
authors.forename: Claudia
authors.initials: C
authors.lastname: Keibl
authors.forename: Johannes
authors.initials: J
authors.lastname: Zipperle
authors.forename: Sylvia
authors.initials: S
authors.lastname: Nürnberger
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Ohlinger
authors.forename: Heinz
authors.initials: H
authors.lastname: Redl
authors.forename: Herbert
authors.initials: H
authors.lastname: Schöchl
mesh_terms: D000818:Animals; D001777:Blood Coagulation / Q000187:drug effects; D016063:Blood Loss, Surgical; D000077324:Crystalloid Solutions; D004195:Disease Models, Animal; D005340:Fibrinogen / Q000008:administration & dosage* / Q000493:pharmacokinetics; D006438:Hemodilution / Q000379:methods*; D006470:Hemorrhage / Q000188:drug therapy* / Q000401:mortality; D006490:Hemostatics / Q000008:administration & dosage; D017148:Infusions, Intraosseous / Q000379:methods*; D007262:Infusions, Intravenous; D007552:Isotonic Solutions / Q000008:administration & dosage; D008297:Male; D011517:Prothrombin Time; D011897:Random Allocation; D012680:Sensitivity and Specificity; D013916:Thrombelastography
chemical_list: D000077324:Crystalloid Solutions; D006490:Hemostatics; D007552:Isotonic Solutions; D005340:Fibrinogen
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