title: A Comparison of the Effects of Intraosseous and Intravenous 5% Albumin on Infusion Time and Hemodynamic Measures in a Swine Model of Hemorrhagic Shock.
abstract: Introduction Obtaining intravenous (IV) access in patients in hemorrhagic shock is often difficult and prolonged. Failed IV attempts delay life-saving treatment. Intraosseous (IO) access may often be obtained faster than IV access. Albumin (5%) is an option for prehospital volume expansion because of the absence of interference with coagulation and platelet function. Hypothesis/Problem There are limited data comparing the performance of IO and IV administered 5% albumin. The aims of this study were to compare the effects of tibial IO (TIO) and IV administration of 500 mL of 5% albumin on infusion time and hemodynamic measurements of heart rate (HR), mean arterial pressure (MAP), cardiac output (CO), and stroke volume (SV) in a swine model of hemorrhagic shock.
  
  
  METHODS
  Sixteen male swine were divided into two groups: TIO and IV. All subjects were anesthetized and a Class III hemorrhage was achieved by exsanguination of 31% of estimated blood volume (EBV) from a femoral artery catheter. Following exsanguination, 500 mL of 5% albumin was administered under pressurized infusion (300 mmHg) by the TIO or IV route and infusion time was recorded. Hemodynamic measurements of HR, MAP, CO, and SV were collected before and after exsanguination and every 20 seconds for 180 seconds during 5% albumin infusion.
  
  
  RESULTS
  An independent t-test determined that IV 5% albumin infusion was significantly faster compared to IO (P=.01). Mean infusion time for TIO was seven minutes 35 seconds (SD=two minutes 44 seconds) compared to four minutes 32 seconds (SD=one minute 08 seconds) in the IV group. Multivariate Analysis of Variance was performed on hemodynamic data collected during the 5% albumin infusion. Analyses indicated there were no significant differences between the TIO and IV groups relative to MAP, CO, HR, or SV (P>.05).
  
  
  CONCLUSIONS
  While significantly longer to infuse 5% albumin by the TIO route, the longer TIO infusion time may be negated as IO devices can be placed more quickly compared to repeated IV attempts. The lack of significant difference between the TIO and IV routes relative to hemodynamic measures indicate the TIO route is a viable route for the infusion of 5% albumin in a swine model of Class III hemorrhage. Muir SL , Sheppard LB , Maika-Wilson A , Burgert JM , Garcia-Blanco J , Johnson AD , Coyner JL . A comparison of the effects of intraosseous and intravenous 5% albumin on infusion time and hemodynamic measures in a swine model of hemorrhagic shock. Prehosp Disaster Med. 2016;31(4):436-442.
authors.affiliation: 1United States Army Medical Department Center and School,Northeastern University,US Army Graduate Program in Anesthesia Nursing,Fort Sam Houston,TexasUSA.
authors.forename: Stacy L
authors.initials: SL
authors.lastname: Muir
authors.affiliation: 1United States Army Medical Department Center and School,Northeastern University,US Army Graduate Program in Anesthesia Nursing,Fort Sam Houston,TexasUSA.
authors.forename: Lance B
authors.initials: LB
authors.lastname: Sheppard
authors.affiliation: 1United States Army Medical Department Center and School,Northeastern University,US Army Graduate Program in Anesthesia Nursing,Fort Sam Houston,TexasUSA.
authors.forename: Anne
authors.initials: A
authors.lastname: Maika-Wilson
authors.affiliation: 1United States Army Medical Department Center and School,Northeastern University,US Army Graduate Program in Anesthesia Nursing,Fort Sam Houston,TexasUSA.
authors.forename: James M
authors.identifier: http://orcid.org/0000-0001-8346-6196
authors.initials: JM
authors.lastname: Burgert
authors.affiliation: 2The Geneva Foundation,Tacoma,WashingtonUSA.
authors.forename: Jose
authors.initials: J
authors.lastname: Garcia-Blanco
authors.affiliation: 1United States Army Medical Department Center and School,Northeastern University,US Army Graduate Program in Anesthesia Nursing,Fort Sam Houston,TexasUSA.
authors.forename: Arthur D
authors.initials: AD
authors.lastname: Johnson
authors.affiliation: 1United States Army Medical Department Center and School,Northeastern University,US Army Graduate Program in Anesthesia Nursing,Fort Sam Houston,TexasUSA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Coyner
mesh_terms: D000418:Albumins / Q000008:administration & dosage*; D000704:Analysis of Variance; D000818:Animals; D004195:Disease Models, Animal; D017148:Infusions, Intraosseous; D007262:Infusions, Intravenous; D008297:Male; D011446:Prospective Studies; D012771:Shock, Hemorrhagic / Q000628:therapy*; D013552:Swine; D013997:Time Factors
chemical_list: D000418:Albumins
keywords: ABP arterial blood pressure; ACS American College of Surgeons; CO cardiac output; DBP diastolic blood pressure; EBV estimated blood volume; FDP freeze-dried plasma; HR heart rate; IO intraosseous; IV intravenous; MAP mean arterial pressure; SBP systolic blood pressure; SV stroke volume; SpO2 oxygen saturation; TBI traumatic brain injury; TIO tibial intraosseous; albumin; hemorrhagic shock; infusion time; intraosseous; resuscitation