Effects of humeral intraosseous versus intravenous epinephrine on pharmacokinetics and return of spontaneous circulation in a porcine cardiac arrest model: A Randomized Control Trial

Publication date: Available online 22 August 2015 Source:Annals of Medicine and Surgery Author(s): Don Johnson, Jose Garcia-Blanco, James Burgert, Lawrence Fulton, Patrick Kadilak, Katherine Perry, Jeffrey Burke Cardiopulmonary Resuscitation (CPR), defibrillation, and epinephrine administration are pillars of advanced cardiac life support (ACLS). Intraosseous (IO) access is an alternative route for epinephrine administration when intravenous (IV) access is unobtainable. Previous studies indicate the pharmacokinetics of epinephrine administration via IO and IV routes differ, but it is not known if the difference influences return of spontaneous circulation (ROSC). The purpose of this prospective, experimental study was to determine the effects of humeral IO (HIO) and IV epinephrine administration during cardiac arrest on pharmacokinetics, ROSC, and odds of survival. Swine (N=21) were randomized into 3 groups: humeral IO (HIO), peripheral IV (IV) and CPR/defibrillation control. Cardiac arrest was induced under general anesthesia. The swine remained in arrest for 2 minutes without intervention. Chest compressions were initiated and continued for 2 minutes. Epinephrine was administered and serial blood samples collected for pharmacokinetic analysis over 4 minutes. Defibrillation and epinephrine administration proceeded according to ACLS guidelines continuing for 20 minutes or until ROSC. Seven HIO swine, 4 IV swine, and no control swine had ROSC. There were no s...
Source: Annals of Medicine and Surgery - Category: Journals (General) Source Type: research