Intraosseous Physiology

Vascular physiology of bone and intraosseal infusions (IOI; bone-marrow, intramarrow infusion) were first described by Drinker et al. in 1922.¹ In 1941, the method was introduced for clinical use by Tocantis et al.^{2, 3} mainly in children.

Bone-marrow transfusion was practiced in Great Britain^4-6 and in South America for emergency cases in the 1940s.⁷ In the Former Soviet Union, the intraosseous route was used in the 1960s for injection of local anesthetics.^8-9 Intraosseal regional anesthesia is a tested and efficient method originally described by Thorn-Alquist¹⁰ and further developed at the Carmel Medical Center.¹¹

The need for minimum time spent in the field, and the benefit of rapid transportation to the trauma center without time wasted by multiple attempts to place an IV line, is extensively discussed in the current literature.^12-14

In emergency situations such as air and road transports of severely compromised patients and
mass casualties from accidents, fires, or explosions, it may be difficult, even for experienced physicians, to gain IV access. In these situations where the establishment of an effective vascular access is imperative, the intraosseous (IO) route is indicated.

Vascular access via the IO route is recommended for use in emergency situations in children by the American Heart Association, the American Academy of Pediatrics,¹⁵ and The American College of Surgeons¹⁶ when venous access is not immediately possible. It is also suitable for use in premature babies, term neonates, infants, children, and adults.^{11, 13, 14, 17-25}
The advantages of using the IO route have been studied in acutely ill children and adults in the prehospital seting.^{13, 22, 23, 26} Highest rates of success were demonstrated in children younger then 3 years old (85%) and the lowest rates in children over 10 years old and in adults (50%). The main causes for failure in this series were errors in landmark identification and bending of needles.²³

Refrences

Relevant Links:

Long Bones Physiology

The IO Principles

X-Rays

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