title: Effects of humeral intraosseous versus intravenous epinephrine on pharmacokinetics and return of spontaneous circulation in a porcine cardiac arrest model: A randomized control trial.
abstract: 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 min without intervention. Chest compressions were initiated and continued for 2 min. Epinephrine was administered and serial blood samples collected for pharmacokinetic analysis over 4 min. Defibrillation and epinephrine administration proceeded according to ACLS guidelines continuing for 20 min or until ROSC. Seven HIO swine, 4 IV swine, and no control swine had ROSC. There were no significant differences in ROSC, maximum concentration; except at 30 s, and time-to-concentration-maximum between the HIO and IV groups. Significant differences existed between the experimental groups and the control. The HIO delivers a higher concentration of epinephrine than the IV route at 30 s which may be a survival advantage. Clinicians may consider using the IO route to administer epinephrine during CA when there is no preexisting IV access or when IV access is unobtainable.
authors.affiliation: Northeastern University, United States Army Graduate Program in Anesthesia Nursing, 3490 Forage Rd., Suite 112, Fort Sam Houston, TX 78234, United States ; The Geneva Foundation, 917 Pacific Ave., Suite 600, Tacoma, WA 98402, United States.
authors.forename: Don
authors.initials: D
authors.lastname: Johnson
authors.affiliation: The Geneva Foundation, 917 Pacific Ave., Suite 600, Tacoma, WA 98402, United States.
authors.forename: Jose
authors.initials: J
authors.lastname: Garcia-Blanco
authors.affiliation: Northeastern University, United States Army Graduate Program in Anesthesia Nursing, 3490 Forage Rd., Suite 112, Fort Sam Houston, TX 78234, United States ; The Geneva Foundation, 917 Pacific Ave., Suite 600, Tacoma, WA 98402, United States.
authors.forename: James
authors.initials: J
authors.lastname: Burgert
authors.affiliation: Texas Tech University, Rawls College of Business, Dept. of Health Organization Management, Rm. 219, Lubbock, TX 79409, United States.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Fulton
authors.affiliation: Northeastern University, United States Army Graduate Program in Anesthesia Nursing, 3490 Forage Rd., Suite 112, Fort Sam Houston, TX 78234, United States.
authors.forename: Patrick
authors.initials: P
authors.lastname: Kadilak
authors.affiliation: Northeastern University, United States Army Graduate Program in Anesthesia Nursing, 3490 Forage Rd., Suite 112, Fort Sam Houston, TX 78234, United States.
authors.forename: Katherine
authors.initials: K
authors.lastname: Perry
authors.affiliation: Northeastern University, United States Army Graduate Program in Anesthesia Nursing, 3490 Forage Rd., Suite 112, Fort Sam Houston, TX 78234, United States.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Burke
keywords: Epinephrine; Intraosseous; Pharmacokinetics; Resuscitation; Return of spontaneous circulation