title: The effects of tibial intraosseous versus intravenous amiodarone administration in a hypovolemic cardiac arrest procine model.
abstract: This study compared the effects of amiodarone via tibial intraosseous (TIO) and intravenous (IV) routes on return of spontaneous circulation (ROSC), time to ROSC, maximum drug concentration (Cmax), time to maximum concentration (Tmax), and mean concentrations over time in a hypovolemic cardiac arrest model.
  
  
  
  Prospective, between subjects, randomized experimental design.
  
  
  
  TriService Research Facility.
  
  
  
  Yorkshire-cross swine (n = 28).
  
  
  
  Swine were anesthetized and placed into cardiac arrest. After 2 minutes, cardiopulmonary resuscitation (CPR) was initiated. After an additional 2 minute, 300 mg of amiodarone were administered via the TIO or the IV route. Blood samples were collected over 5 minutes. The plasma concentrations were analyzed using high-performance liquid chromatography tandem mass spectrometry.
  
  
  
  ROSC, time to ROSC, Cmax, Tmax, and mean concentrations over time.
  
  
  
  A multivariate analysis of variance indicated that there were no significant differences in the TIO and IV groups in ROSC (p = 0.515), time to ROSC (p = 0.300), Cmax (p = 0.291), or Tmax (p = 0.475). The mean Cmax of the TIO group was 56,292 ± 11,504 ng/mL compared to 74,258 ± 11,504 ng/mL for the IV group. The Tmax for TIO and IV groups were 120 ± 25 and 94 ± 25, respectively. A repeated measures analysis of variance indicated that there were no significant differences between the groups relative to concentrations over time (p > 0.05).
  
  
  
  The TIO provides rapid and reliable access to administer lifesaving medications during cardiac arrest.
authors.affiliation: Student, US Army Graduate Program in Anesthesia Nursing, Fort Sam Houston, San Antonio, Texas.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Hampton
authors.affiliation: Student, US Army Graduate Program in Anesthesia Nursing, Fort Sam Houston, San Antonio, Texas.
authors.forename: Eric
authors.initials: E
authors.lastname: Wang
authors.affiliation: Student, US Army Graduate Program in Anesthesia Nursing, Fort Sam Houston, San Antonio, Texas.
authors.forename: Jerome Ivan
authors.initials: JI
authors.lastname: Argame
authors.affiliation: Student, US Army Graduate Program in Anesthesia Nursing, Fort Sam Houston, San Antonio, Texas.
authors.forename: Tom
authors.initials: T
authors.lastname: Bateman
authors.affiliation: Faculty Member and Veterans Administration Representative, US Army Graduate Program in Anesthesia Nursing, Fort Sam Houston, San Antonio, Texas.
authors.forename: William
authors.initials: W
authors.lastname: Craig
authors.affiliation: Faculty Member and Director of Research, US Army Graduate Program in Anesthesia Nursing, Fort Sam Houston, San Antonio, Texas.
authors.forename: Don
authors.initials: D
authors.lastname: Johnson
mesh_terms: D000638:Amiodarone / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D000818:Animals; D016887:Cardiopulmonary Resuscitation; D002851:Chromatography, High Pressure Liquid; D004195:Disease Models, Animal; D006323:Heart Arrest / Q000188:drug therapy*; D020896:Hypovolemia / Q000188:drug therapy*; D017148:Infusions, Intraosseous; D007262:Infusions, Intravenous; D011446:Prospective Studies; D011897:Random Allocation; D013552:Swine; D053719:Tandem Mass Spectrometry
chemical_list: D000638:Amiodarone