title: Effects of humerus intraosseous versus intravenous amiodarone administration in a hypovolemic porcine model.
abstract: To compare the effects of amiodarone administration by humerus intraosseous (HIO) and intravenous (IV) routes on return of spontaneous circulation (ROSC), time to maximum concentration (Tmax), maximum plasma drug concentration (Cmax), time to ROSC, 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 was initiated. After an additional 2 minutes, amiodarone 300 mg was administered via the HIO or the IV route. Blood samples were collected over 5 minutes. The samples were analyzed using high-performance liquid chromatography tandem mass spectrometry.
  
  
  
  ROSC, Tmax, Cmax, time to ROSC, and mean concentrations over time.
  
  
  
  There was no difference in ROSC between the HIO and IV groups; each had five achieve ROSC and two that did not (p = 1). There was no difference in Tmax (p = 0.501) or in Cmax between HIO and IV groups (p = 0.232). Means ± standard deviations in seconds were 94.3 ± 78.3 compared to 115.7 ± 87.3 in the IV versus HIO groups, respectively. The mean ± standard deviation in nanograms per milliliter for the HIO was 49,041 ± 21,107 and 74,258 ± 33,176 for the IV group. There were no significant differences between the HIO and IV groups relative to time to ROSC (p = 0.220). A repeated analysis of variance indicated that there were no significant differences between the groups relative to concentrations over time (p > 0.05).
  
  
  
  The humerus intraosseous provides rapid and reliable access to administer life-saving medications during cardiac arrest.
authors.affiliation: US Army Graduate Program in Anesthesia Nursing, JBSA-FSH, San Antonio, Texas.
authors.forename: Cpt Monica M
authors.initials: CM
authors.lastname: Holloway
authors.affiliation: US Army Graduate Program in Anesthesia Nursing, JBSA-FSH, San Antonio, Texas.
authors.forename: Cpt Shannan L
authors.initials: CS
authors.lastname: Jurina
authors.affiliation: US Army Graduate Program in Anesthesia Nursing, JBSA-FSH, San Antonio, Texas.
authors.forename: Cpt Joshua D
authors.initials: CJ
authors.lastname: Orszag
authors.affiliation: US Army Graduate Program in Anesthesia Nursing, JBSA-FSH, San Antonio, Texas.
authors.forename: Lt George R
authors.initials: LG
authors.lastname: Bragdon
authors.affiliation: US Army Graduate Program in Anesthesia Nursing, JBSA-FSH, San Antonio, Texas.
authors.forename: Lt Rustin D
authors.initials: LR
authors.lastname: Green
authors.affiliation: Texas Tech University Health Science Center at El Paso, El Paso, Texas.
authors.forename: Jose C
authors.initials: JC
authors.lastname: Garcia-Blanco
authors.affiliation: US Army Graduate Program in Anesthesia Nursing, JBSA-FSH, San Antonio, Texas.
authors.forename: Brian E
authors.initials: BE
authors.lastname: Benham
authors.affiliation: US Army Graduate Program in Anesthesia Nursing, JBSA-FSH, San Antonio, Texas.
authors.forename: Ltc Timothy S
authors.initials: LT
authors.lastname: Adams
authors.affiliation: US Army Graduate Program in Anesthesia Nursing, JBSA-FSH, 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*; D006811:Humerus; 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