Intraosseous infusion of drugs and fluids in critical patients: a systematic review

OBJECTIVE. To systematically review the literature to identify drugs, fluids, and blood products administered through intraosseous devices during emergencies, and to determine the flow rates used for infusions.
METHODS. We searched the following databases: Dialnet, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Science Direct, the Spanish National Research Council (CSIC), ProQuest, Scopus, LILACS, Current Contents, PubMed, the Cochrane Librarly Plus, and the Spanish Virtual Health Library (BVS), Cuiden, Cuidatge, the Clinical Online Network of Evidence for Care and Therapeutics (JBI Connect +), and the MEDES search engine. In addition we searched databases for doctoral theses and similar texts: Teseo, TDR, and the document repository of the University of Alicante (RUA). Metasearch engines used were the Trip Medical Database and Google Scholar. The following electronic journals were searched directly: Evidence-Based Nursing, Evidence-Based Medicine, Enfermería Global, Rol de Enfermería, Emergencias, Nursing Research and Practice, NURE Investigation, Revista Científica de Enfermería, American Journal of Critical Care, The New England Journal of Medicine, and Journal of Critical Care and Nursing Research. Publisher and other web portals for journal groups were also consulted: BioMed Central, Directory of Open Access Journals, Nursing Center, Internet Scientific Publications (ISPUB), RACO (Catalan Open Access Journals), Scielo, and Elsevier. This approach followed the PRISMA recommendations for conducting systematic reviews. We analyzed full texts and specified inclusion criteria governing experimental and quasi-experimental research designs and assessed methodological quality. Articles selected could be published between 2000 and 2021 in Castilian Spanish, English, or Catalan.
RESULTS. Twenty-four articles were included. Among the numerous drugs that were administered through an intraosseous access device were epinephrin, dopamine, dobutamine, adenosine, digitalis, heparin, lidocaine, atropine, and fibrinolytics. Fluids (crystalloids and colloids) were also infused. High flow rates were reported. Blood product transfusions were not followed by hemolysis. Use of intraosseous infusion also allowed valid blood samples to be taken for analysis of blood gases and hemoglobin, sodium, potassium, magnesium, lactic acid, and calcium concentrations.
CONCLUSION. Intraosseous infusion is an option to consider when drugs must be administered rapidly in emergencies other than cardiopulmonary resuscitation.