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Kristiansen S, Storm B, Dahle D, et al. Intraosseous fluid resuscitation causes systemic fat emboli in a porcine hemorrhagic shock model. Scand J Trauma Resusc Emerg Med. 2021;29(1):172doi: 10.1186/s13049-021-00986-z.
Kristiansen, S., Storm, B., Dahle, D., Domaas Josefsen, T., Dybwik, K., Nilsen, B. A., & Waage-Nielsen, E. (2021). Intraosseous fluid resuscitation causes systemic fat emboli in a porcine hemorrhagic shock model. Scandinavian journal of trauma, resuscitation and emergency medicine, 29(1), 172. https://doi.org/10.1186/s13049-021-00986-z
Kristiansen, Steinar, et al. "Intraosseous fluid resuscitation causes systemic fat emboli in a porcine hemorrhagic shock model." Scandinavian journal of trauma, resuscitation and emergency medicine vol. 29,1 (2021): 172. doi: https://doi.org/10.1186/s13049-021-00986-z
Kristiansen S, Storm B, Dahle D, Domaas Josefsen T, Dybwik K, Nilsen BA, Waage-Nielsen E. Intraosseous fluid resuscitation causes systemic fat emboli in a porcine hemorrhagic shock model. Scand J Trauma Resusc Emerg Med. 2021 Dec 20;29(1):172. doi: 10.1186/s13049-021-00986-z. PMID: 34930433.
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Scand J Trauma Resusc Emerg Med. 2021 Dec 20;29(1):172. doi: 10.1186/s13049-021-00986-z.

Intraosseous fluid resuscitation causes systemic fat emboli in a porcine hemorrhagic shock model.

Scandinavian journal of trauma, resuscitation and emergency medicine

Steinar Kristiansen, Benjamin Storm, Dalia Dahle, Terje Domaas Josefsen, Knut Dybwik, Bent Aksel Nilsen, Erik Waage-Nielsen

Affiliations

  1. Surgery and Intensive Care Unit, University Hospital of Northern Norway, Tromsø, Norway. [email protected].
  2. Department of Surgery, Nordland Hospital Trust, Bodø, Norway. [email protected].
  3. Department of Clinical Medicine, Faculty of Health Sciences, Arctic University of Norway, Tromsø, Norway. [email protected].
  4. Department of Surgery, Nordland Hospital Trust, Bodø, Norway.
  5. Department of Clinical Medicine, Faculty of Health Sciences, Arctic University of Norway, Tromsø, Norway.
  6. Research Laboratory, Nordland Hospital Trust, Bodø, Norway.
  7. Faculty of Biosciences and Aquaculture, Nord University, Bodø, Norway.
  8. Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway.
  9. Department of Immunology, Oslo University Hospital, University of Oslo, Oslo, Norway.

PMID: 34930433 DOI: 10.1186/s13049-021-00986-z

Abstract

BACKGROUND: Intraosseous cannulation can be life-saving when intravenous access cannot be readily achieved. However, it has been shown that the procedure may cause fat emboli to the lungs and brain. Fat embolization may cause serious respiratory failure and fat embolism syndrome. We investigated whether intraosseous fluid resuscitation in pigs in hemorrhagic shock caused pulmonary or systemic embolization to the heart, brain, or kidneys and if this was enhanced by open chest conditions.

METHODS: We induced hemorrhagic shock in anesthetized pigs followed by fluid-resuscitation through bilaterally placed tibial (hind leg) intraosseous cannulas. The fluid-resuscitation was limited to intraosseous or i.v. fluid therapy, and did not involve cardiopulmonary resuscitation or other interventions. A subgroup underwent median sternotomy with pericardiectomy and pleurotomy before hemorrhagic shock was induced. We used invasive hemodynamic and respiratory monitoring including Swan Ganz pulmonary artery catheter and transesophageal echocardiography and obtained biopsies from the lungs, heart, brain, and left kidney postmortem.

RESULTS: All pigs exposed to intraosseous infusion had pulmonary fat emboli in postmortem biopsies. Additionally, seven of twenty-one pigs had coronary fat emboli. None of the pigs with open chest had fat emboli in postmortem lung, heart, or kidney biopsies. During intraosseous fluid-resuscitation, three pigs developed significant ST-elevations on ECG; all of these animals had coronary fat emboli on postmortem biopsies.

CONCLUSIONS: Systemic fat embolism occurred in the form of coronary fat emboli in a third of the animals who underwent intraosseous fluid resuscitation. Open chest conditions did not increase the incidence of systemic fat embolization.

© 2021. The Author(s).

Keywords: Coronary fat embolism; Fat embolism; Fat embolism syndrome; Intraosseous cannulation; Open chest conditions; Systemic embolization

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