TY - JOUR
T1 - Fat embolism with the use of intraosseous infusion during cardiopulmonary resuscitation
AU - Fiallos, Mariano
AU - Kissoon, Niranjan
AU - Abdelmoneim, Talaat
AU - Johnson, Lindsey
AU - Murphy, Suzanne
AU - Lu, Leo
AU - Masood, Shahla
AU - Idris, Ahamed
N1 - Funding Information:
Submitted October 1, 1996; accepted in revised form February 28, 1997. Presented in part at the Southern Society for Pediatric Research, Southern Regional Meeting, New Orleans, Louisiana, February, 1996 (recipient of the Southern Society for Pediatric Research Trainee Travel Award), at the 25th Educational and Scientific Symposium, Society of Critical Care Medicine, New Orleans, Louisiana, February 1996, and at the Society for Pediatric Research Meeting, Washington, DC, May 1996 This research was funded by the Deans Fund/University of Florida and Groh Foundation. Correspondence: Niranjan Kissoon, MD, FCCM, 820 Prudential Drive, Howard Building, Suite 203, Jacksonville, FL 32207.
PY - 1997/8
Y1 - 1997/8
N2 - 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.
AB - 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.
KW - Cardiopulmonary resuscitation
KW - Embolism
KW - Intraosseous infusions
KW - Vascular access
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U2 - 10.1097/00000441-199708000-00008
DO - 10.1097/00000441-199708000-00008
M3 - Article
C2 - 9258208
AN - SCOPUS:0030871440
SN - 0002-9629
VL - 314
SP - 73
EP - 79
JO - American Journal of the Medical Sciences
JF - American Journal of the Medical Sciences
IS - 2
ER -