A comparison of intravenous access sites for bolus injections during shock and resuscitation after emergency room thoracotomy with and without aortic crossclamping.

Thoracotomy with aortic crossclamping is used to resuscitate trauma victims. Pharmacologic boluses are often given via intravenous lines of central, brachial, or femoral origin. This study was undertaken to determine the efficacy of intravenous access site on delivery of a bolus injection to the heart with thoracotomy and aortic crossclamping during shock and resuscitation. Six dogs were anesthetized, intubated, and underwent brachial and femoral venotomy and Swan-Ganz insertion (central). Baseline measurements of central, brachial, and femoral transit times for 10 cc cold saline were obtained via Swan-Ganz thermistor. Each animal then underwent thoracotomy, aortic crossclamping alone, hemorrhage to blood pressure (BP) 50 mm Hg for 30 minutes with aorta unclamped and then aorta crossclamped and resuscitation with lactated Ringer's Solution with aorta unclamped and then crossclamped. Femoral-Brachial Index (FBI) was determined by dividing femoral transit time by brachial transit time at each observation. The data suggest that femoral access significantly prolongs bolus transit time when compared with central or brachial access during aortic crossclamping in the euvolemic, shock, or aggressively resuscitated model. Brachial access is therefore the preferred route for bolus injection delivery in the emergency room thoracotomy with or without aortic crossclamping because it provides expedient bolus delivery equal to central access and superior to femoral access.