Comparison study of intraosseous, central intravenous, and peripheral intravenous infusions of emergency drugs.
Intraosseous infusion of emergency drugs is a lifesaving alternative to intravenous administration when intravenous access cannot be rapidly established. We studied the comparative pharmacokinetics of the following six emergency drugs and solutions: epinephrine hydrochloride, 0.01 mg/kg; sodium bicarbonate, 1 mEq/kg; calcium chloride, 10 mg/kg; hydroxyethyl starch, 10 mL/kg; 50% dextrose in water, 250 mg/kg; and lidocaine hydrochloride, 1 mg/kg. Studies were conducted in normotensive, anesthetized dogs, with three animals studied with each of the drugs or solutions and each animal being treated with all three routes of administration (central intravenous, peripheral intravenous, and intraosseous) in randomized sequence. The effects of epinephrine were also assessed in a shock model. The intraosseous route of administration was comparable with the central and peripheral intravenous routes for all of the emergency drugs and solutions studied, with equivalent magnitudes of peak effect or drug level and equal or longer durations of action. Time to placement of the intraosseous needle varied from 15 seconds to 5 minutes, with a mean of 60 seconds. Time to placement of the needle varies with the skill and experience of the individual. With experience, all individuals could place the intraosseous needle in 60 seconds or less. The intraosseous route is comparable in effect to the central and peripheral intravenous routes of drug administration for epinephrine, sodium bicarbonate, hydroxyethyl starch, calcium chloride, 50% dextrose in water, and lidocaine and is a clinically feasible alternative when intravenous access will be critically delayed.
Pediatric and Surgical Intensive Care Unit, Cleveland Clinic Foundation, Ohio 44195-5086.
J P
JP
Orlowski
D T
DT
Porembka
J M
JM
Gallagher
J D
JD
Lockrem
F
F
VanLente
D000818:Animals; D001639:Bicarbonates / Q000008:administration & dosage / Q000493:pharmacokinetics; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure / Q000187:drug effects; D001853:Bone Marrow; D002122:Calcium Chloride / Q000008:administration & dosage / Q000493:pharmacokinetics; D004285:Dogs; D004630:Emergencies; D004837:Epinephrine / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000494:pharmacology; D005947:Glucose / Q000008:administration & dosage / Q000493:pharmacokinetics; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage / Q000493:pharmacokinetics; D007260:Infusion Pumps; D007262:Infusions, Intravenous / Q000379:methods*; D008012:Lidocaine / Q000008:administration & dosage / Q000493:pharmacokinetics; D004364:Pharmaceutical Preparations / Q000008:administration & dosage*; D012964:Sodium / Q000008:administration & dosage / Q000493:pharmacokinetics; D017693:Sodium Bicarbonate
D001639:Bicarbonates; D001786:Blood Glucose; D006895:Hydroxyethyl Starch Derivatives; D004364:Pharmaceutical Preparations; D017693:Sodium Bicarbonate; D008012:Lidocaine; D012964:Sodium; D005947:Glucose; D002122:Calcium Chloride; D004837:Epinephrine