Fat embolism with the use of intraosseous infusion during cardiopulmonary resuscitation

Mariano Fiallos, Niranjan Kissoon, Talaat Abdelmoneim, Lindsey Johnson, Suzanne Murphy, Leo Lu, Shahla Masood, Ahamed Idris

Research output: Contribution to journalArticle

34 Scopus citations

Abstract

The objective of this prospective study was to assess the incidence and magnitude of fat emboli after cardiopulmonary resuscitation and intraosseous infusions. An animal laboratory at a university center was used to study 33 mixed-breed piglets. The piglets underwent hypoxic cardiac arrest followed by chest compressions and mechanical ventilation for a minimum of 30 minutes. The animals were divided in groups: group 1 (n = 5), which had no intraosseous cannulas, group 2 (n = 6), which had intraosseous cannulas with no infusion, groups 3 (n = 6), 4 (n = 6), and 5 (n = 8), which had intraosseous cannulas with infusion of epinephrine, normal saline, and sodium bicarbonate respectively, and group 6 (n = 2), which was a sham group with no intraosseous cannulas and no cardiopulmonary resuscitation. At cessation of cardiopulmonary resuscitation, representative lung samples were collected from upper and lower lobes of each lung and observed for fat globules and bone marrow elements. Fat globules were seen in the peribronchial blood vessels and intravascular areas throughout all lung fields of groups 1 through 5. There was no difference in appearance or distribution of fat globules among the 5 treatment groups. Analysis of variance showed no statistical significance (P < 0.05) within or among groups 1 through 5. The use of the intraosseous cannula for infusion of emergency drugs and fluids did not increase the magnitude of fat embolization over cardiopulmonary resuscitation alone in this animal model. The benefits of using this procedure in critically ill children as a means of rapid vascular access for resuscitation is well established. However, the risk of fat embolism in this population needs further study.

Original languageEnglish (US)
Pages (from-to)73-79
Number of pages7
JournalAmerican Journal of the Medical Sciences
Volume314
Issue number2
DOIs
StatePublished - Aug 1997

Keywords

  • Cardiopulmonary resuscitation
  • Embolism
  • Intraosseous infusions
  • Vascular access

ASJC Scopus subject areas

  • Medicine(all)

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