Mock drug delivery to the proximal aorta during cardiopulmonary resuscitation: central vs peripheral intravenous infusion with varying flush volumes.
OBJECTIVE
To compare mock drug deliveries to the proximal aorta during CPR after peripheral vs central i.v. administration when the mock drug is followed by different postinfusion flush volumes.


METHODS
Delivery of indocyanine green (ICG) dye to the proximal aorta of an instrumented 20-kg canine cardiac arrest model was examined. The ICG administration (2.5 mg) preceded either a 2-mL or a 10-mL saline flush, for either a central or a peripheral i.v. route of dye administration. Five dogs each underwent three sets of the four possible route/flush-volume combinations in a stratified randomized order. Real-time dye-absorbance-vs-time curves, as sampled from the proximal aorta, modeled central-circulation drug delivery. Systolic and diastolic blood pressures (BPs) were monitored, and the absorbance-vs-time curve upstroke phases were used to estimate cardiac output during arrest.


RESULTS
Times (mean +/- SD) to onset of dye appearance did not differ significantly between peripheral/10 mL (126 +/- 35 sec) and central/10 mL (108 +/- 35 sec), or between central/2 mL (123 +/- 31 sec) and central/10 mL. Times to onset of dye appearance did differ between peripheral/2 mL (161 +/- 70 sec) and central/10 mL [analysis of variance (ANOVA) p = 0.032]. Times to peak dye concentration did not differ significantly between peripheral/10 mL (230 +/- 88 sec) and either central/10 mL (202 +/- 88 sec) or central/2 mL (215 +/- 83 sec), but differed between peripheral/2 mL (326 +/- 134 sec) and every other route/flush-volume combination (ANOVA p = 0.009). Peak dye concentrations and systolic/diastolic BPs (averaging 23/10 for all route/flush-volume combinations) did not differ significantly between any route/flush-volume combinations.


CONCLUSIONS
An adequately sized postinfusion crystalloid flush (0.5 mL/kg) permits peripherally administered model drug to reach the central circulation as quickly and in equivalent concentration as centrally administered drug during CPR in a canine cardiac arrest model.
Gaddis
G M
GM
University of Missouri-Kansas City School of Medicine, USA.
Dolister
M
M
Gaddis
M L
ML
D000704:Analysis of Variance; D000818:Animals; D001013:Aorta, Thoracic; D001795:Blood Pressure Determination; D002302:Cardiac Output / Q000187:drug effects*; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002405:Catheterization, Central Venous / Q000379:methods; D002406:Catheterization, Peripheral / Q000379:methods; D004396:Coloring Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics; D004195:Disease Models, Animal; D004285:Dogs; D004305:Dose-Response Relationship, Drug; D006323:Heart Arrest / Q000188:drug therapy*; D007208:Indocyanine Green / Q000008:administration & dosage* / Q000493:pharmacokinetics; D007262:Infusions, Intravenous; D011897:Random Allocation
D004396:Coloring Agents; D007208:Indocyanine Green