Hypertonic Saline Dextran (HSD) and Intraosseous Vascular Access for the Treatment of Haemorrhagic Hypotension in the Far-forward Combat Arena

Battlefield statistics show that 50% of deaths are due to acute haemorrhage. Hypertonic (7.5% saline)/hyperoncotic (6% Dextran-70) solution (HSD) for the treatment of haemorrhagic hypotension may have physiologic and logistic advantages over conventional fluid therapy for use in the far-forward combat arena. HSD rapidly expands plasma volume and stabilizes haemodynamic variables in various animal models of haemorrhage, at a volume dose of about 1/10 of conventional lactated Ringers solution. However, combat conditions, as well as the physiological status of the patient may result in time delays or failure to achieve vascular access. Over the past 5 years we have investigated intraosseous infusion of HSD via the sternum or tibia, as a possible means of achieving rapid vascular access and plasma volume expansion. These data in experimental animals and one clinical study show that HSD can be safely and rapidly infused via the intraosseous route achieving the same haemodynamic benefit as observed with intravenous administration.