Effects of sternal intraosseous and intravenous administration of Hextend on time of administration and hemodynamics in a swine model of hemorrhagic shock


  • Don Johnson, PhD
  • Christian Penaranda, BSN
  • Kent Phillips, BSN
  • Daniel Rice, BSN
  • Lauren Vanderhoek, BSN
  • Brian Gegel, CRNA, DNAP
  • James Burgert, CRNA, DNAP
  • Jose Blanco, MD




hemorrhage, shock, Hextend, Hetastarch, infusion time, intraosseous


Objective: Disasters may cause traumatic injuries leading to hemorrhage. Hemorrhage is the leading cause of death for military and civilian trauma casualties. The US Army's Tactical Combat Casualty Care guidelines recommend administering a 500 mL Hextend bolus via the intravenous (IV) or intraosseous (IO) routes for patients in hypovolemic shock. The purposes of this study were to compare administration time of Hextend and the effects on hemodynamics when Hextend is administered by the sternal IO (SIO) and IV routes in a swine model of hemorrhagic shock.

Design: This was a prospective, experimental study with random assignment.

Setting: The study was implemented at an animal vivarium.

Subjects: Yorkshire-cross (N = 21) swine were used.

Intervention: Each swine was hemorrhaged 30 percent of their total blood volume to simulate a class II hemorrhage; 500 mL of Hextend was administered by the SIO and IV routes after hemorrhage. The control group did not receive any resuscitative fluids.

Main outcome measurements: The predetermined variables of the study were time of administration and hemodynamics over 8 minutes. Hemodynamic data were collected every 2 minutes until administration was complete.

Results: There were no significant differences in the time to administer Hextend between the SIO (616 ± 166 seconds) and the IV groups (534 ± 151 seconds) (p = 0.37). There were no significant differences between the SIO and IV groups relative to hemodynamics (p > 0.05), but both were significantly different than the control group (p < 0.05).

Conclusion: The SIO route is an effective method of administering Hextend.

Author Biographies

Don Johnson, PhD

Director of Research and Professor, US Army Graduate Program in Anesthesia, Fort Sam Houston, Texas.

Christian Penaranda, BSN

Student at the US Army Graduate Program in Anesthesia Nursing, Fort Sam Houston, Texas.


Kent Phillips, BSN

Student at the US Army Graduate Program in Anesthesia Nursing, Fort Sam Houston, Texas

Daniel Rice, BSN

Student at the US Army Graduate Program in Anesthesia Nursing, Fort Sam Houston, Texas

Lauren Vanderhoek, BSN

Student at the US Army Graduate Program in Anesthesia Nursing, Fort Sam Houston, Texas

Brian Gegel, CRNA, DNAP

Veteran Anesthesia Services, San Antonio, Texas; Coinvestigator, Geneva Foundation, Tacoma, Washington.

James Burgert, CRNA, DNAP

Assistant Professor, US Army Graduate Program in Anesthesia Nursing, Fort Sam Houston, Texas; Coinvestigator, Geneva Foundation, Tacoma, Washington

Jose Blanco, MD

Coinvestigator, Geneva Foundation, Tacoma, Washington


Lennquist S: Medical Response to Major Incidents and Disasters: A Practical Guide for All Medical Staff. New York City, New York: Springer, 2012.

Elster EA, Butler FK, Rasmussen TE: Implications of combat casualty care for mass casualty events. JAMA. 2013; 310(5): 475-476.

Bellamy RF: The causes of death in conventional land warfare: Implications for combat casualty care research. Mil Med. 1984; 149(2): 55-62.

Pope A, French G, Longnecker DE (eds.): Fluid Resuscitation: State of the Science for Treating Combat Casualties and Civilian Injuries. Washington, DC: National Academies Press, 1999.

Lyon RM, Donald M: Intraosseous access in the prehospital setting-ideal first-line option or best bailout? Resuscitation. 2013; 84(4): 405-406.

Gonzalez RP, Cummings GR, Phelan HA, et al.: On-scene intravenous line insertion adversely impacts prehospital time in rural vehicular trauma. Am Surg. 2008; 74(11): 1083-1087.

Johnson D, Dial J, Ard J, .: Effects of intraosseous and intravenous administration of hextend(R) on time of administration and hemodynamics in a Swine model. J Spec Oper Med. 2014; 14(1): 79-85.

Faul F, Erdfelder E, Buchner A, et al.: Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behav Res Methods. 2009; 41(4): 1149-1160.

Paquette S, Gordon C, Bradtmiller B: Anthropometric survey (ANSUR) II pilot study: Methods and summary statistics. Natick, MA: US Army Natick Soldier Research, Development and Engineering Center, 2009: 74-75.

Swindle MM, Makin A, Herron AJ, et al.: Swine as models in biomedical research and toxicology testing. Vet Pathol. 2012; 49(2): 344-356.

Hannon JP, Wade CE, Bossone CA, et al.: Oxygen delivery and demand in conscious pigs subjected to fixed-volume hemorrhage and resuscitated with 7.5% NaCl in 6% dextran. Circ Shock. 1989; 29(3): 205-217.

Wade CE, Hannon JP, Bossone CA, et al.: Resuscitation of conscious pigs following hemorrhage: Comparative efficacy of small-volume resuscitation. Circ Shock. 1989; 29(3): 193-204.

Davidoff J, Fowler R, Gordon D, et al.: Clinical evaluation of a novel intraosseous device for adults: Prospective, 250-patient, multi-center trial. JEMS. 2005; 30(10): suppl 20-23.

Frascone RJ, Jensen JP, Kaye K, et al.: Consecutive field trials using two different intraosseous devices. Prehosp Emerg Care. 2007; 11(2): 164-171.

Drinker CK, Drinker KR, Lund CC: The circulation in the mammalian bone marrow. Am J Physiol. 1922; 62(1): 1-92.

Josefson A: A new method of treatment—Intraossal injections. Acta Med Scand. 1934; 81(Fasc. V-VI): 550-564.

Orlowski JP: My kingdom for an intravenous line. Am J Dis Child. 1984; 138(9): 803.

Santos D, Carron PN, Yersin B, et al.: EZ-IO((R)) intraosseous device implementation in a pre-hospital emergency service: A prospective

study and review of the literature. Resuscitation. 2013; 84(4): 440-445.

Leidel BA, Kirchhoff C, Bogner V, et al.: Comparison of intraosseous versus central venous vascular access in adults under resuscitation in the emergency department with inaccessible peripheral veins. Resuscitation. 2012; 83(1): 40-45.

Dolister M, Miller S, Borron S, et al.: Intraosseous vascular access is safe, effective and costs less than central venous catheters for patients in the hospital setting. J Vasc Access. 2013; 14(3): 216-224.

Wilkes NJ, Woolf RL, Powanda MC, et al.: Hydroxyethyl starch in balanced electrolyte solution (Hextend)—Pharmacokinetic and pharmacodynamic profiles in healthy volunteers. Anesth Analg. 2002; 94(3): 538-544.

Care CoTCC: Tactical Combat Casualty Care Guidelines. 2014. Available at http://www.health.mil/Libraries/120917_TCCC_Course_Materials/TCCC-Guidelines-120917.pdf. Accessed March 15, 2015.

Butler FK, Holcomb JB, Schreiber MA, et al.: Fluid resuscitation for hemorrhagic shock in tactical combat casualty care: TCCC guidelines change 14-01 - 2 June 2014. J Spec Oper Med. 2014; 14(3): 13-38.

Lairet J, Bebarta V, Lairet K, et al.: A comparison of proximal tibia, distal femur, and proximal humerus infusion rates using the EZ-IO intraosseous device on the adult swine (Sus scrofa) model. Prehosp Emerg Care. 2013; 17(2): 280-284.

Society IAR: Poiseuille's Law: IV Fluids. 2013. Available at http://www.openanesthesia.org/poiseuilles_law_iv_fluids/. Accessed March 23, 2015.

Harris M, Balog R, Devries G: What is the evidence of utility for intraosseous blood transfusion in damage-control resuscitation? J Trauma Acute Care Surg. 2013; 75(5): 904-906.

Malkiewicz A, Dziedzic M: Bone marrow reconversion—Imaging of physiological changes in bone marrow. Pol J Radiol. 2012; 77(4): 45-50.

Hannon JP, Bossone CA, Wade CE: Normal physiological values for conscious pigs used in biomedical research. Lab Anim Sci. 1990; 40(3): 293-298.

Bakovic D, Eterovic D, Saratlija-Novakovic Z, et al.: Effect of human splenic contraction on variation in circulating blood cell counts. Clin Exp Pharmacol Physiol. 2005; 32(11): 944-951.



How to Cite

Johnson, PhD, D., C. Penaranda, BSN, K. Phillips, BSN, D. Rice, BSN, L. Vanderhoek, BSN, B. Gegel, CRNA, DNAP, J. Burgert, CRNA, DNAP, and J. Blanco, MD. “Effects of Sternal Intraosseous and Intravenous Administration of Hextend on Time of Administration and Hemodynamics in a Swine Model of Hemorrhagic Shock”. American Journal of Disaster Medicine, vol. 10, no. 1, Jan. 2015, pp. 61-67, doi:10.5055/ajdm.2015.0189.




Most read articles by the same author(s)

1 2 > >>