The World War II Anesthesiology Roots of Intraosseous
Authors: Shantanu Srinivasan MD, David B Waisel MD
Affiliation: Childrens Hospital, Boston
Intraosseous vascular access is recognized as a safe and effective alternative to
intravenous access in pediatric emergencies such as trauma, burns and acutely ill patients.
The 1980s brought about a resurrection of this valuable technique, primarily through the
work of the pediatrician James Orlowski, MD. He was a great proponent of this technique
and his seminal article “My Kingdom for an Intravenous Line” built the foundation for
the resurgence of interest in intraosseous access. But few know that the intraosseous
technique has its clinical roots in World War II anesthesiology
In 1922, the circulation in bone marrow was described. Nearly 20 years later,
hematologists working on bone marrow transplantation in laboratory animals described
the intraosseous route for administering fluids and blood into the general circulation.
They went on to describe the clinical use of intraosseous access in both adults and
infants. Emanuel M. Papper (future Chair of Anesthesiology at Columbia University and
President of the ASA) was influenced by their work and began studying intraosseous
access. As presented at a national anesthesia meeting on December 11, 1941 and
subsequently published in 1942, Papper was the first to establish that human circulating
time for intraosseous and intravenous administration was nearly identical. In 7 patients he
compared the circulation time of the antecubital vein and the marrow of the sternum.
Using injections of macasol and 2% sodium cyanide, Papper found that the average
circulation time was slightly less for the intraosseous injection than for the intravenous
injection. He also showed that anesthesia drugs could be administered through the
intraosseous route. His papers also describe various case reports of intraosseous use in
adults and infants.
Of course, World War II began for the United S