El acceso intraóseo para fluidoterapia en situación de combate. Experiencia de la sanidad militar española en Afganistán

Objectives: To describe the Spanish military medical staff's experience with the use of intraosseous lines for fluid therapy in a combat zone. Patients and methods: Descriptive study of 25 patients (30 needles). The patients were injured by firearms or explosive devices, or had multiple injuries, and were attended by Spanish military physicians in western Afghanistan (Herat) between March 2007 and June 2008. Results: The bone puncture was performed on 19 patients in prehospital settings. The remaining 6 patients underwent the procedure in the Spanish military hospital. All patients were men; the mean (SD) age was 26 (2.3) years. Most belonged to the Afghan National Army (64%) and had injuries caused by explosive devices (68%). The largest percentage of injuries involved the lower limbs (56%). A line could be inserted in 76% of the cases (100% at the military hospital). The first-choice site of puncture was the anterior tibial tuberosity. Fluids and medications were successfully administered through the intraosseous lines. No complications occurred during needle insertion, but 5 patients reported pain. Conclusion: Our experience suggests that intraosseous access can provide an alternative to venous access for treating trauma patients in combat zones.