Effects of Humeral Intraosseous Epinephrine in a Pediatric Hypovolemic Cardiac Arrest Porcine Model

Overview

Journal Trauma Surg Acute Care Open

Specialty Critical Care

Date 2020 Mar 11

PMID 32154374

Citations 1

Authors

Michael James Neill

James M Burgert

Dawn Blouin

Benjamin Tigges

Kari Rodden

Rachel Roberts

Phillip Anderson

Travis Hallquist

John Navarro

Joseph OSullivan

Don Johnson

Affiliations

Soon will be listed here.

Abstract

Background: Aims of the study were to determine the effects of humerus intraosseous (HIO) versus intravenous (IV) administration of epinephrine in a hypovolemic, pediatric pig model. We compared concentration maximum (Cmax), time to maximum concentration (Tmax), mean concentration (MC) over time and return of spontaneous circulation (ROSC).

Methods: Pediatric pig were randomly assigned to each group (HIO (n=7); IV (n=7); cardiopulmonary resuscitation (CPR)+defibrillation (defib) (n=7) and CPR-only group (n=5)). The pig were anesthetized; 35% of the blood volume was exsanguinated. pigs were in arrest for 2 min, and then CPR was performed for 2 min. Epinephrine 0.01 mg/kg was administered 4 min postarrest by either route. Samples were collected over 5 min. After sample collection, epinephrine was administered every 4 min or until ROSC. The Cmax and MC were analyzed using high-performance liquid chromatography. Defibrillation began at 3 min postarrest and administered every 2 min or until ROSC or endpoint at 20 min after initiation of CPR.

Results: Analysis indicated that the Cmax was significantly higher in the IV versus HIO group (p=0.001). Tmax was shorter in the IV group but was not significantly different (p=0.789). The MC was significantly greater in the IV versus HIO groups at 90 and 120 s (p<0.05). The IV versus HIO had a significantly higher MC (p=0.001). χ indicated the IV group (5 out of 7) had significantly higher rate of ROSC than the HIO group (1 out of 7) (p=0.031). One subject in the CPR+defib and no subjects in the CPR-only groups achieved ROSC.

Discussion: Based on the results of our study, the IV route is more effective than the HIO route.

Citing Articles

Intravenous vs. intraosseous vascular access during out-of-hospital cardiac arrest - protocol for a randomised clinical trial.

Meilandt C, Vallentin M, Blumensaadt Winther K, Bach A, Dissing T, Christensen S Resusc Plus. 2023; 15:100428.

PMID: 37502742 PMC: 10368931. DOI: 10.1016/j.resplu.2023.100428.

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