The safety of intraosseous infusions: Risks of fat and bone marrow emboli to the lungs

Abstract

The technique of intraosseous infusion is a life-saving emergency alternative when IV access is impossible or will be critically delayed. Concerns about its safety remain, especially concerning the risk of bone marrow and fat emboli to the lungs. We examined autopsy pulmonary specimens on two children who had received intraosseous infusions during resuscitation attempts and found an average of 0.23 to 0.71 bone marrow and fat emboli per mm2 of lung. We studied normotensive dogs with intraosseous infusions of emergency drugs and solutions into the distal femur. Three dogs were studied with each of the following emergency drugs or solutions: controls with normal saline (0.9% NaCl), epinephrine 0.01 mg/kg, NaHCO3 1 mEq/kg, CaCl 10 mg/kg, atropine 0.01 mg/kg, hydroxyethyl starch 6% in normal saline 10 mL/kg, 50% dextrose in water 0.25 g/kg, and lidocaine 1 mg/kg. Four hours after infusion, the animals were killed, and representative sections of the lung were examined with oil red-0 and hematoxylin and eosin stains for the presence of fat and bone marrow emboli. Fat and bone marrow emboli were found in all lung sections, varying from 0.11 to 4.48 emboli/mm2 lung (mean, 0.91 emboli/mm2 lung) for the emergency drugs and solutions and 0.06 to 0.53 emboli/mm2 (mean, 0.29 emboli/mm2 lung) for the controls. Analysis of variance revealed no significant difference (P = .07) in mean number of fat and bone marrow emboli per square millimeter of lung among the emergency drugs and compared with controls.(ABSTRACT TRUNCATED AT 250 WORDS)