title: Comparison of tibial intraosseous, sternal intraosseous, and intravenous routes of administration on pharmacokinetics of epinephrine during cardiac arrest: a pilot study.
abstract: The purpose of this study was to determine and compare the maximum concentration (C(max)) and time to maximum concentration (T(max)) of epinephrine administered via tibial intraosseous (IO), sternal IO, and intravenous (i.v.) routes in a porcine model of cardiac arrest during cardiopulmonary resuscitation. Five pigs each were randomly assigned to 3 groups: tibial IO, sternal IO, and i.v. Cardiac arrest was induced with i.v. potassium chloride. After 2 minutes, cardiopulmonary resuscitation was initiated. Epinephrine was administered to each animal, and serial blood samples were collected over the next 3 minutes. Enzyme-linked immunosorbent assay was used to determine the epinephrine concentration. Multivariate analysis of variance helped determine if there were statistically significant differences between groups. There were significant differences in Cmax between the sternal IO and i.v. (P = .009) and tibial IO and i.v. (P = .03) groups but no significant difference between tibial and sternal IO groups (P = .75). Significant differences existed in Tmax between the tibial IO and i.v. (P = .04) and between tibial IO and sternal IO (P = .02) groups but no difference between the sternal IO and i.v. groups (P = .56). Intravenous administration of 1 mg of epinephrine resulted in a serum concentration 5.87 and 2.86 times greater than for the tibial and sternal routes, respectively.
authors.affiliation: Brooke Army Medical Center, Fort Sam Houston, Texas, USA. jburgert@sbcglobal.net
authors.forename: James
authors.initials: J
authors.lastname: Burgert
authors.forename: Brian
authors.initials: B
authors.lastname: Gegel
authors.forename: Michael
authors.initials: M
authors.lastname: Loughren
authors.forename: Thomas
authors.initials: T
authors.lastname: Ceremuga
authors.forename: Manish
authors.initials: M
authors.lastname: Desai
authors.forename: Michael
authors.initials: M
authors.lastname: Schlicher
authors.forename: Joseph
authors.initials: J
authors.lastname: O'Sullivan
authors.forename: Paul
authors.initials: P
authors.lastname: Lewis
authors.forename: Don
authors.initials: D
authors.lastname: Johnson
mesh_terms: D000818:Animals; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D004837:Epinephrine / Q000097:blood / Q000493:pharmacokinetics*; D006323:Heart Arrest / Q000139:chemically induced / Q000188:drug therapy*; D017148:Infusions, Intraosseous / Q000379:methods*; D007262:Infusions, Intravenous / Q000379:methods; D010865:Pilot Projects; D013249:Sternum; D013552:Swine; D013566:Sympathomimetics / Q000097:blood / Q000493:pharmacokinetics; D013977:Tibia
chemical_list: D013566:Sympathomimetics; D004837:Epinephrine