Recovery of fibrinogen concentrate after intraosseous application is equivalent to the intravenous route in a porcine model of hemodilution
| Autor: | Christoph J. Schlimp, Claudia Keibl, Heinz Redl, Wolfgang Öhlinger, Cristina Solomon, Sylvia Nürnberger, Herbert Schöchl, Johannes Zipperle |
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| Rok vydání: | 2014 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Blood Loss Surgical Hemorrhage Critical Care and Intensive Care Medicine Fibrinogen Sensitivity and Specificity Hemostatics Random Allocation medicine Animals Intraosseous access Infusions Intravenous Blood Coagulation fibrinogen concentrate traumatic hemorrhage Prothrombin time Hemodilution hemostatic therapy medicine.diagnostic_test business.industry Balanced Crystalloid Solution pigs Crystalloid Solutions Original Articles Infusions Intraosseous Thrombelastography Surgery Disease Models Animal Thromboelastometry Intraosseous infusion Coagulation Anesthesia Prothrombin Time Isotonic Solutions business Fluid replacement Partial thromboplastin time medicine.drug |
| Zdroj: | The Journal of Trauma and Acute Care Surgery |
| ISSN: | 2163-0755 |
| DOI: | 10.1097/ta.0000000000000174 |
| Popis: | 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. CONCLUSION 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. LEVEL OF EVIDENCE Prospective, randomized, therapeutic feasibility study in an animal model, level V. |
| Databáze: | OpenAIRE |
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