title: Pharmacokinetics of intraosseous and central venous drug delivery during cardiopulmonary resuscitation.
abstract: We compared the pharmacokinetics of intraosseous (IO) drug delivery via tibia or sternum, with central venous (CV) drug delivery during cardiopulmonary resuscitation (CPR).
  
  
  METHODS
  CPR of anesthetized KCl arrest swine was initiated 8 min post arrest. Evans blue and indocyanine green, each were simultaneously injected as a bolus with adrenaline through IO sternal and tibial needles, respectively, n=7. In second group (n=6) simultaneous IO sternal and IV central venous (CV) injections were made.
  
  
  RESULTS
  Peak arterial blood concentrations were achieved faster for sternal IO vs. tibial IO administration (53±11 s vs. 107±27 s, p=0.03). Tibial IO dose delivered was 65% of sternal administration (p=0.003). Time to peak blood concentration was similar for sternal IO and CV administration (97±17 s vs. 70±12 s, respectively; p=0.17) with total dose delivered of sternal being 86% of the dose delivered via CV (p=0.22).
  
  
  CONCLUSIONS
  IO drug administrations via either the sternum or tibia were effective during CPR in anesthetized swine. However, IO drug administration via the sternum was significantly faster and delivered a larger dose.
authors.affiliation: Resuscitation Research Laboratory, Department of Anaesthesiology, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555-0801, USA.
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Hoskins
authors.forename: Paulo
authors.initials: P
authors.lastname: do Nascimento
authors.forename: Rodrigo M
authors.initials: RM
authors.lastname: Lima
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Espana-Tenorio
authors.forename: George C
authors.initials: GC
authors.lastname: Kramer
mesh_terms: D000818:Animals; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002405:Catheterization, Central Venous / Q000379:methods*; D004396:Coloring Agents / Q000008:administration & dosage / Q000493:pharmacokinetics*; D004195:Disease Models, Animal; D004305:Dose-Response Relationship, Drug; D004837:Epinephrine / Q000008:administration & dosage / Q000493:pharmacokinetics*; D005070:Evans Blue / Q000008:administration & dosage / Q000493:pharmacokinetics; D007208:Indocyanine Green / Q000008:administration & dosage / Q000493:pharmacokinetics; D017148:Infusions, Intraosseous / Q000379:methods*; D007262:Infusions, Intravenous / Q000379:methods*; D058687:Out-of-Hospital Cardiac Arrest / Q000097:blood / Q000628:therapy*; D013053:Spectrophotometry; D013249:Sternum; D013552:Swine; D013977:Tibia
chemical_list: D004396:Coloring Agents; D005070:Evans Blue; D007208:Indocyanine Green; D004837:Epinephrine