Calf Compartment Syndrome associated with the Use of an Intra-osseous Line in an Adult Patient: A Case Report

Compartment Syndrome Secondary to Intraosseous Access Abutting Tibial Stem Cement Mantle of a Total Knee Arthroplasty: A Case Report

CASE

A 79-year-old man 6 days status-post left total knee arthroplasty (TKA) presented to our institution from an outside hospital (OSH) after a suspected STEMI and ventricular fibrillation arrest. At the OSH, intraosseous (IO) access was placed in his right tibia. Orthopaedics was consulted for compartment syndrome at the IO access site. X-rays demonstrated this was secondary to the IO access abutting the cement mantle of a stemmed tibial component of a remote TKA, for which the patient required emergent fasciotomies.

CONCLUSIONS

Healthcare providers should be cognizant of potential orthopaedic hardware that can impede proper introduction of IO access.

Complications of Intraosseous Access: Two Case Reports From a Single Center

CASES

Intraosseous (IO) access is an effective surrogate for intravascular access in critically ill patients. We present 2 cases of IO complications. The first patient is a 44-year-old man with deep peroneal nerve sensorimotor dysfunction due to possible missed acute compartment syndrome from improper placement of a tibial IO needle. The second patient is an immunosuppressed 69-year-old man with idiopathic factor VIII deficiency who required amputation 7 months after right tibia IO access.

CONCLUSION

These adverse events of IO access are limited in the literature. We make recommendations to reduce these outcomes.

Intraosseous access in the resuscitation of trauma patients: a literature review

PURPOSE

Intraosseous (IO) catheters continue to be recommended in trauma resuscitation. Their utility has recently been debated due to concerns regarding inadequate flow rates during blood transfusion, and the potential for haemolysis. The objective of this review was to examine the evidence for intraosseous catheters in trauma resuscitation, and to highlight areas for future research.

METHODS

A PubMed and Embase search for articles published from January 1990 to August 2018 using the terms ("intra-osseous access" or "intraosseous access" or "IO access") AND trauma was performed. Original articles describing the use of an IO catheter in the resuscitation of one or more trauma patients were eligible. Animal, cadaveric studies and those involving healthy volunteers were excluded.

RESULTS

Nine studies, comprising of 1218 trauma patients and 1432 device insertions, were included. The insertion success rate was 95% and the incidence of complications 0.9%. Flow-rate data and evidence of haemolysis were poorly reported.

CONCLUSION

Intraosseous catheters have high insertion success rates and a low incidence of complications in trauma patients. Existing evidence suggests that IO transfusion is not associated with haemolysis, however, further studies in humans are needed. There is a paucity of flow rate data for blood transfusion via IO catheters in this population, although much anecdotal evidence advocating their use exists.