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"Iliac crest intraosseous (IO) placement is an alternative when peripheral sites such as the humeral head and tibia are not available options" Fulghum et al (2021).

Iliac crest intraosseous access

Abstract:

Low-titer cold-stored O-positive whole blood (LTCSO+WB) resuscitation therapy is the cornerstone of military hemorrhagic shock resuscitation. During the past 19 years, improved patient outcomes have shown the importance of this intervention in shock treatment. Iliac crest intraosseous (IO) placement is an alternative when peripheral sites such as the humeral head and tibia are not available options. To date, no study has explored the administration of LTCSO+WB through an iliac crest IO in the military prehospital setting. Contingency procedures for vascular access are necessary for casualties with severe trauma to all four extremities, and the iliac crest is a viable option. The literature supports situational advantages over other peripheral IO sites.

Reference:

Fulghum GH 3rd, Gravano B, Foudrait A, Rush SC, Paladino L. Prehospital Iliac Crest Intraosseous Whole Blood Infusion. J Spec Oper Med. 2021 Winter;21(4):90-93. PMID: 34969134.