title: Effects of tibial and humerus intraosseous administration of epinephrine in a cardiac arrest swine model.
abstract: Compare maximum concentration (Cmax), time to maximum concentration (Tmax), mean serum concentration of epinephrine, return of spontaneous circulation (ROSC), time to ROSC, and odds of survival relative to epinephrine administration by humerus intraosseous (HIO), tibial intraosseous (TIO), and intravenous (IV) routes in a swine 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, a dose of 1 mg of epinephrine was administered by HIO, TIO, or the IV routes. Blood samples were collected over 4 minutes and analyzed by high-performance liquid chromatography tandem mass spectrometry.
  
  
  
  ROSC, time to ROSC, Cmax, Tmax, mean concentrations over time, and odds ratio.
  
  
  
  There was no significant difference in rate of the ROSC among the TIO, HIO, and IV groups (p > 0.05). There were significant differences in Cmax: the HIO group was significantly higher than the TIO group (p = 0.007), but no significant difference between the IV and HIO (p = 0.33) or the IV and TIO group (p = 0.060). The Tmax was significantly shorter for both the IV and HIO versus the TIO group (p < 0.05), but no difference between IV and HIO (p = 0.328). The odds of survival were higher in the HIO group compared to all other groups.
  
  
  
  The TIO and HIO provide rapid and reliable access to administer life-saving medications during cardiac arrest.
authors.affiliation: Faculty Member, US Army Graduate Program in Anesthesia Nursing, JBSA-FSH, San Antonio, Texas.
authors.forename: Ltc Denise
authors.initials: LD
authors.lastname: Beaumont
authors.affiliation: Candidate, School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, Texas.
authors.forename: Asal
authors.initials: A
authors.lastname: Baragchizadeh
authors.affiliation: President, Peloton College, Dallas, Texas.
authors.forename: Charles
authors.initials: C
authors.lastname: Johnson
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: D000818:Animals; D016887:Cardiopulmonary Resuscitation; D004195:Disease Models, Animal; D004837:Epinephrine / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D006323:Heart Arrest / Q000188:drug therapy*; D006811:Humerus; D017148:Infusions, Intraosseous; D007262:Infusions, Intravenous; D011446:Prospective Studies; D011897:Random Allocation; D013552:Swine; D013977:Tibia
chemical_list: D004837:Epinephrine