Effects of intravenous, sternal, and humerus intraosseous administration of Hextend on time of administration and hemodynamics in a hypovolemic swine model


  • Dawn Blouin, BS
  • Brian T. Gegel, DNAP, CRNA
  • Don Johnson, PhD
  • Jose C. Garcia-Blanco, MD




Hextend, intraosseous, hypovolemic shock


Objective: To determine if there were significant differences among humerus intraosseous (HIO), sternal intraosseous (SIO), and intravenous (IV) administration of 500 mL Hextend in hemodynamics or administration time in a hypovolemic swine model.

Setting: Vivarium.

Subjects: Yorkshire swine; sample size was based on a large effect size of 0.5, an α of 0.05, and a power of 80 percent Swine were randomly assigned to one of four groups: HIO (n = 9), SIO (n = 9), IV (n = 9), and control (n = 9).

Intervention: Swine were exsanguinated 30 percent of their blood volume. Hextend (500 mL) was administered by either the HIO, SIO, or IV route; the control group received none.

Main Outcome: Time of administration of Hextend; systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), cardiac output (CO), and stroke volume (SV) data were collected every 2 minutes and compared by group over 8 minutes.

Results: A repeated analysis of variance found that there were no significant differences in SBP, DBP, MAP, HR, CO, and SV among HIO, SIO, and IV groups over 8 minutes (p > 0.05). An analyses of variance determined that there was no significant difference between groups relative to time of administration (p = 0.521).

Conclusion: When IV access is difficult, both HIO and SIO are effective techniques for rapid vascular access and the administration of Hextend for patients in hypovolemic shock.

Author Biographies

Dawn Blouin, BS

Research Coordinator, Geneva Foundation, Tacoma, Washington

Brian T. Gegel, DNAP, CRNA

CEO/Owner, Gegel Anesthesia Services, San Antonio, Texas

Don Johnson, PhD

Faculty Member, US Army Graduate Program in Anesthesia Nursing, Fort Sam Houston, San Antonio, Texas

Jose C. Garcia-Blanco, MD

Texas Tech University Health Science Center at El Paso, El Paso, Texas.


Lapostolle F, Catineau J, Garrigue B, et al.: Prospective evaluation of peripheral venous access difficulty in emergency care. Intensive Care Med. 2007; 33(8): 1452-1457.

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.

Burgert JM, Mozer J, Williams T, et al.: Effects of intraosseous transfusion of whole blood on hemolysis and transfusion time in a swine model of hemorrhagic shock: a pilot study. AANA J. 2014; 82(3): 198-202.

Johnson D, Dial J, Ard J, et al.: 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.

Deakin CD, Nolan JP, Soar J, et al.: European Resuscitation Council guidelines for resuscitation 2010 section 4. Adult advanced life support. Resuscitation. 2010; 81(10): 1305-1352.

Link MS, Berkow LC, Kudenchuk PJ, et al.: Part 7: Adult advanced cardiovascular life support: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015; 132(18)(suppl 2): S444-S464.

Nolan JP, Hazinski MF, Aickin R, et al.: Part 1: Executive summary: 2015 international consensus on cardiopulmonary resuscitation and

emergency cardiovascular care science with treatment recommendations. Resuscitation. 2015; 95: e1-31.

Soar J, Callaway CW, Aibiki M, et al.: Part 4: Advanced life support: 2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Resuscitation. 2015; 95: e71-120.

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.

Martini WZ, Dubick MA, Blackbourne LH: Comparisons of lactated Ringer's and Hextend resuscitation on hemodynamics and coagulation following femur injury and severe hemorrhage in pigs. J Trauma Acute Care Surg. 2013; 74(3): 732-739.

Kheirabadi BS, Crissey JM, Deguzman R, et al.: In vivo bleeding time and in vitro thrombelastography measurements are better indicators of dilutional hypothermic coagulopathy than prothrombin time. J Trauma. 2007; 62(6): 1352-1359; discussion 1359-1361.

Kheirabadi BS, Crissey JM, Deguzman R, et al.: Effects of synthetic versus natural colloid resuscitation on inducing dilutional coagulopathy and increasing hemorrhage in rabbits. J Trauma. 2008; 64(5): 1218-1228; discussion 1228-1219.

Kheirabadi BS, Valdez-Delgado KK, Terrazas IB, et al.: Is limited prehospital resuscitation with plasma more beneficial than using a synthetic colloid?. An experimental study in rabbits with parenchymal bleeding. J Trauma Acute Care Surg. 2015; 78(4): 752-759.

Ogilvie MP, Pereira BM, McKenney MG, et al.: First report on safety and efficacy of hetastarch solution for initial fluid resuscitation at a level 1 trauma center. J Am Coll Surg. 2010; 210(5): 870-880, 880-872.

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.

Report of the task group on reference man. Ann ICRP. 1979; 3(1-4): iii.

Johnson D, Penaranda C, Phillips K, et al.: Effects of sternal intraosseous and intravenous administration of Hextend on time of administration and hemodynamics in a swine model of hemorrhagic shock. Am J Disaster Med. 2015; 10(1): 61-67.

Paquette S, Gordon C, Bradtmiller B: Anthropometric survey II pilot study: Methods and summary statistics. In US Army Natick Soldier Research, Development and Engineering Center. Natick, MA: US Army, 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.

Kauvar DS, Lefering R, Wade CE: Impact of hemorrhage on trauma outcome: An overview of epidemiology, clinical presentations, and therapeutic considerations. J Trauma. 2006; 60(6)(suppl): S3-S11.

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. Circulatory 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. Circulatory Shock. 1989; 29(3): 193-204.

Anson JA: Vascular access in resuscitation: Is there a role for the intraosseous route? Anesthesiology. 2014; 120(4): 1015-1031.

Hallas P, Brabrand M, Folkestad L: Complication with intraosseous access: Scandinavian users’ experience. West J Emerg Med. 2013; 14(5): 440-443.



How to Cite

Blouin, BS, D., B. T. Gegel, DNAP, CRNA, D. Johnson, PhD, and J. C. Garcia-Blanco, MD. “Effects of Intravenous, Sternal, and Humerus Intraosseous Administration of Hextend on Time of Administration and Hemodynamics in a Hypovolemic Swine Model”. American Journal of Disaster Medicine, vol. 11, no. 3, July 2016, pp. 183-92, doi:10.5055/ajdm.2016.0238.

Similar Articles

You may also start an advanced similarity search for this article.

Most read articles by the same author(s)

1 2 > >>