title: Effects of tibial intraosseous and IV administration of vasopressin on kinetics and survivability in cardiac arrest.
abstract: OBJECTIVE
  Purposes of this study were to compare tibial intraosseous (TIO) and intravenous (IV) administration of vasopressin relative to return of spontaneous circulation (ROSC) and time to ROSC in an adult swine cardiac arrest model. In addition, the purposes were to compare the concentration maximum (Cmax), time to maximum concentration (Tmax), and odds of ROSC.
  
  
  METHODS
  This was a between-subjects, prospective experimental study. Yorkshire swine (N = 21) were randomly assigned to 1 of 3 groups: TIO, IV, or control groups. The swine were anesthetized and instrumented, and then cardiac arrest was induced and sustained for 2 minutes. Cardiopulmonary resuscitation was initiated and continued for 2 minutes. Vasopressin was then administered via the TIO or IV route. Blood samples were collected for 4 minutes to determine the Cmax and Tmax of vasopressin. Concentration maximum and Tmax were calculated by use of liquid chromatography with mass spectrometry.
  
  
  RESULTS
  There was no difference in ROSC between the TIO and IV groups (P = .63). The Cmax of vasopressin was significantly higher in the IV group compared to the TIO group (P = .017). However, there was no significant difference in ROSC, time to ROSC, or Tmax between groups (P > .05). All subjects had ROSC in both the IV and TIO groups, and none had ROSC in the control group. There was 225 times greater chance of survival for both the IV and TIO groups compared to the control group.
  
  
  CONCLUSIONS
  The data support that the TIO is an effective route for vasopressin in a cardiac arrest model.
authors.affiliation: Department of the Army, Academy of Health Sciences, Fort Sam Houston, TX 78234-6130. Electronic address: arthurjohnso@gmail.com.
authors.forename: Don
authors.initials: D
authors.lastname: Johnson
authors.affiliation: Department of the Army, Academy of Health Sciences, Fort Sam Houston, TX 78234-6130. Electronic address: Giles.k@husky.neu.edu.
authors.forename: Kirk
authors.initials: K
authors.lastname: Giles
authors.affiliation: Department of the Army, Academy of Health Sciences, Fort Sam Houston, TX 78234-6130. Electronic address: acuna.a@husky.neu.edu.
authors.forename: Alexis
authors.initials: A
authors.lastname: Acuna
authors.affiliation: Department of the Army, Academy of Health Sciences, Fort Sam Houston, TX 78234-6130. Electronic address: saenz.c@husky.neu.edu.
authors.forename: Crystal
authors.initials: C
authors.lastname: Saenz
authors.affiliation: Department of the Army, Academy of Health Sciences, Fort Sam Houston, TX 78234-6130. Electronic address: armygas@gmail.com.
authors.forename: Michael
authors.initials: M
authors.lastname: Bentley
authors.affiliation: Department of the Army, Academy of Health Sciences, Fort Sam Houston, TX 78234-6130. Electronic address: craig.budinich@gmail.com.
authors.forename: Craig
authors.initials: C
authors.lastname: Budinich
mesh_terms: D000818:Animals; D016887:Cardiopulmonary Resuscitation; D002853:Chromatography, Liquid; D004195:Disease Models, Animal; D006323:Heart Arrest / Q000188:drug therapy*; D017148:Infusions, Intraosseous; D007262:Infusions, Intravenous; D013058:Mass Spectrometry; D011446:Prospective Studies; D013552:Swine; D013977:Tibia; D014667:Vasopressins / Q000008:administration & dosage* / Q000493:pharmacokinetics*
chemical_list: D014667:Vasopressins