Effects of humeral intraosseous epinephrine in a pediatric hypovolemic cardiac arrest porcine model. Issue 1 (18th February 2020)

• Record Type: Journal Article
• Authors: Neill, Michael James; Burgert, James M; Blouin, Dawn; Tigges, Benjamin; Rodden, Kari; Roberts, Rachel; Anderson, Phillip; Hallquist, Travis; Navarro, John; O'Sullivan, Joseph; Johnson, Don
• Is Part Of: Trauma surgery & acute care open. Volume 5:Issue 1(2020)
• Publication Date: 2020-02-18
• Subjects: Traumatology -- Periodicals; Critical care medicine -- Periodicals; Wounds and injuries -- Periodicals; 617.1
• DOI: 10.1136/tsaco-2019-000372
• Languages: English
• ISSNs: 2397-5776

Abstract

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 2 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.