Humerus intraosseous administration of epinephrine in normovolemic and hypovolemic porcine model

2018 ◽  
Vol 13 (2) ◽  
pp. 97-106
Author(s):  
LTC Robert P. Long, II, PhD, CRNA ◽  
LTC Stephanie M. Gardner, DNP, CRNA ◽  
James Burgert, DNAP, CRNA ◽  
LTC Craig A. Koeller, DVM, DACLAM, AFRL ◽  
LTC Joseph O’Sullivan, PhD, CRNA ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Blood Volume ◽  
Maximum Concentration ◽  
Porcine Model ◽  
Spontaneous Circulation ◽  
Rate Of Return ◽  
Blood Samples ◽  
Return Of Spontaneous Circulation ◽  
Mean Concentration ◽  
Over Time

Objective: Compare the maximum concentration (Cmax), time to maximum concentration (Tmax), mean concentration, rate of return of spontaneous circulation (ROSC), time to ROSC, and odds of ROSC when epinephrine is administered by humerus intraosseous (HIO) compared to intravenous (IV) routes in both a hypovolemic and normovolemic cardiac arrest model.Design: Prospective, between subjects, randomized experimental study.Setting: TriService Facility.Subjects: Twenty-eight adult Yorkshire Swine were randomly assigned to four groups: HIO normovolemia; HIO hypovolemia; IV normovolemia; and IV hypovolemia.Intervention: Swine were anesthetized. The hypovolemic group was exsanguinated 31 percent of their blood volume. Subjects were placed into arrest. After 2 minutes, cardiopulmonary resuscitation (CPR) was initiated. After another 2 minutes, 1 mg epinephrine was given by IV or HIO routes; blood samples were collected over 4 minutes. Hypovolemic groups received 500 mL of 5 percent albumin following blood sampling. CPR continued until ROSC or for 30 minutes.Main outcome measures: ROSC, time to ROSC, Cmax, Tmax, mean concentrations over time, odds of ROSC.Results: Cmax was significantly higher, the Tmax, and the time to ROSC were significantly faster in the HIO normovolemic compared to the HIO hypovolemic group (p 0.05). All seven in the HIO normovolemic group achieved ROSC compared to three of the HIO hypovolemic group. Odds of ROSC were 19.2 times greater in the HIO normovolemic compared the HIO hypovolemic group.Conclusion: The HIO is an effective route in a normovolemic model. However, the findings indicate that sufficient blood volume is essential for ROSC in a hypovolemic scenario.

scholarly journals Effects of humeral intraosseous epinephrine in a pediatric hypovolemic cardiac arrest porcine model

2020 ◽  
Vol 5 (1) ◽  
pp. e000372
Author(s):  
Michael James Neill ◽  
James M Burgert ◽  
Dawn Blouin ◽  
Benjamin Tigges ◽  
Kari Rodden ◽  
...  
Keyword(s):  
High Performance ◽  
Porcine Model ◽  
Spontaneous Circulation ◽  
Sample Collection ◽  
Return Of Spontaneous Circulation ◽  
Concentration Maximum ◽  
Group 5 ◽  
Mean Concentration ◽  
Over Time ◽  
Group 1

BackgroundAims 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).MethodsPediatric 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.ResultsAnalysis 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). χ2 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.DiscussionBased on the results of our study, the IV route is more effective than the HIO route.

scholarly journals Effects of Endotracheal Administration of Epinephrine in Cardiac Arrest of Adult and Pediatric Swine

2019 ◽  
Vol 3 (2) ◽  
pp. p34
Author(s):  
Steven Kertes ◽  
Valentina Fillman ◽  
Brandon Krawczyk ◽  
Logan Hirsch ◽  
Allison Martin ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Area Under The Curve ◽  
Spontaneous Circulation ◽  
Average Weight ◽  
Male Adult ◽  
Epinephrine Administration ◽  
Blood Samples ◽  
Return Of Spontaneous Circulation ◽  
Significant Difference ◽  
Adults And Children

BACKGROUND: Few studies have investigated the effects of hypovolemia on area under the curve (AUC) and the return of spontaneous circulation (ROSC) comparing adults and children in cardiac arrest.AIMS: To compare the epinephrine endotracheal (ET) administration relative to AUC, rate, time to, and odds of achieving ROSC between hypovolemic adult and pediatric cardiac arrest models.METHODS: This was an experimental study using male Adult ET and Pediatric ET swine. Pediatric ET pigs (N=7) weighed 20-30 kg representing the average weight for a child between 5 and 6 years of age. Adult ET pigs (N=7) weighed 60 to 80 kg. All were exsanguinated 35% of their blood volume. Swine were put into arrest for 2 minutes. Cardiopulmonary resuscitation (CPR) was initiated for 2 minutes; epinephrine was then administered. Blood samples were collected over 5 minutes. RESULTS: No significant difference occurred in AUC between the groups (p > 0.05). The Pediatric ET group had higher rates of ROSC and a shorter time to ROSC (p < 0.05). Pediatric ET group had a 15 times greater odds of achieving ROSC compared to the Adult ET group. CONCLUSION: Based on the results of this study, we recommend epinephrine administration via ET within the pediatric arrest model, but not for the adult.

Infant and Pediatric Cardiopulmonary Resuscitation

2021 ◽  
pp. 183-190
Author(s):  
Sarah Nizamuddin
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Spontaneous Circulation ◽  
Rate Of Return ◽  
High Quality ◽  
Return Of Spontaneous Circulation ◽  
Shockable Rhythm ◽  
Level Of Importance

High-quality cardiopulmonary resuscitation (CPR) in children with cardiac arrest is vitally important to increase the chance of survival. The rate of return of spontaneous circulation from in-hospital cardiac arrests has improved between 2001 and 2013, from 39% to 77%. In adults, cardiac arrest is most commonly due to primary cardiac causes. In contrast, the cause of pediatric cardiac arrest is often asphyxia resulting in hypoxia. Because of this difference, there is a greater level of importance given to ventilation during infant and pediatric CPR. After recognition of the loss of pulse or blood pressure, quick initiation of CPR is necessary to provide blood flow to vital organs. Ensuring high-quality cardiopulmonary resuscitation in pediatric patients requires knowledge of the appropriate equipment, medications, and procedures. Quick recognition of the loss of spontaneous circulation should trigger an immediate call for help and initiation of chest compressions. Ventilation should be supported, and defibrillation should be performed when the patient is in a shockable rhythm. Epinephrine and other medications may also be required.

scholarly journals The Prognosis of Cardiac Origin and Noncardiac Origin in-Hospital Cardiac Arrest Occurring during Night Shifts

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Yuan-Jhen Syue ◽  
Jyun-Bin Huang ◽  
Fu-Jen Cheng ◽  
Chia-Te Kung ◽  
Chao-Jui Li
Keyword(s):  
Cardiac Arrest ◽  
Night Shift ◽  
Survival Rates ◽  
Spontaneous Circulation ◽  
The Other ◽  
Rate Of Return ◽  
Return Of Spontaneous Circulation ◽  
The Difference ◽  
Hospital Cardiac Arrest ◽  
Night Shifts

Background.The survival rates of in-hospital cardiac arrests (IHCAs) are reportedly low at night, but the difference between the survival rates of cardiac origin and noncardiac origin IHCAs occurring at night remains unclear.Methods.Outcomes of IHCAs during different shifts (night, day, and evening) were compared and stratified according to the etiology (cardiac and noncardiac origin).Result.The rate of return of spontaneous circulation (ROSC) was 24.7% lower for cardiac origin IHCA and 19.4% lower for noncardiac origin IHCA in the night shift than in the other shifts. The survival rate was 8.4% lower for cardiac origin IHCA occurring during the night shift, but there was no difference for noncardiac origin IHCA. After adjusting the potential confounders, chances of ROSC (aOR: 0.3, CI: 0.15–0.63) and survival to discharge (aOR: 0.1; CI: 0.01–0.90) related to cardiac origin IHCA were lower during night shifts. Regarding noncardiac origin IHCA, chances of ROSC (aOR: 0.5, CI: 0.30–0.78) were lower in the night shift, but chances of survival to discharge (aOR: 1.3, CI: 0.43–3.69) were similar in these two groups.Conclusion.IHCA occurring at night increases mortality, and this is more apparent for cardiac origin IHCAs than for noncardiac origin IHCA.

The effects of sternal intraosseous and intravenous administration of amiodarone in a hypovolemic swine cardiac arrest model

2016 ◽  
Vol 11 (4) ◽  
pp. 271-277 ◽  
Author(s):  
Samuel Smith, BSN ◽  
Bradley Borgkvist, BSN ◽  
Teara Kist, BSN ◽  
Jason Annelin, BSN ◽  
Don Johnson, PhD ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
High Performance ◽  
Multivariate Analyses ◽  
Plasma Concentrations ◽  
Spontaneous Circulation ◽  
Blood Samples ◽  
Life Saving ◽  
Concentration Maximum ◽  
Liquid Chromatography Tandem Mass ◽  
Over Time

Objective: This study compared the effects of amiodarone via sternal intraosseous (SIO) and intravenous (IV) routes on return of spontaneous circulation (ROSC), time to ROSC, concentration maximum (Cmax), time to maximum concentration (Tmax), and mean concentrations over time in a hypovolemic cardiac arrest model.Design: Prospective, between subjects, randomized experimental design.Setting: TriService Research Facility.Subjects: Yorkshire-cross swine (n = 28).Intervention: 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 tibial intraosseous 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.Main Outcome Measurements: ROSC, time to ROSC, Cmax, Tmax, and mean concentrations over time.Results: A multivariate analyses of variance indicated that there were no significant differences in the SIO and IV groups in ROSC (p = 0.191), time to ROSC (p 0.05), Tmax mean 88.1 ± 24.8 seconds versus 49.5 ± 21.8 seconds (p = 0.317), or Cmax mean 92,700 ± 161,112 ng/mL versus 64,159.8 ± 14,174.8 ng/mL (p = 0.260). A repeated analyses of variance indicated that there were no significant differences between the groups relative to concentrations over time (p 0.05).Conclusion: The SIO provides rapid and reliable access to administer life-saving medications during cardiac arrest.

Effects of tibial and humerus intraosseous administration of epinephrine in a cardiac arrest swine model

2016 ◽  
Vol 11 (4) ◽  
pp. 243-251 ◽  
Author(s):  
Denise Beaumont, MSN, CRNA ◽  
Asal Baragchizadeh, MS, PhD Candidate ◽  
Charles Johnson, MA ◽  
Don Johnson, PhD
Keyword(s):  
Cardiac Arrest ◽  
Maximum Concentration ◽  
High Performance ◽  
Spontaneous Circulation ◽  
Swine Model ◽  
Epinephrine Administration ◽  
Life Saving ◽  
Significant Difference ◽  
Liquid Chromatography Tandem Mass ◽  
Over Time

Objective: 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.Design: Prospective, between subjects, randomized experimental design.Setting: TriService Research Facility.Subjects: Yorkshire-cross swine (n = 28).Intervention: 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.Main Outcome Measurements: ROSC, time to ROSC, Cmax, Tmax, mean concentrations over time, and odds ratio.Results: 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.Conclusion: The TIO and HIO provide rapid and reliable access to administer life-saving medications during cardiac arrest.

The comparison of humeral intraosseous and intravenous administration of vasopressin on return of spontaneous circulation and pharmacokinetics in a hypovolemic cardiac arrest swine model

2016 ◽  
Vol 11 (4) ◽  
pp. 237-242 ◽  
Author(s):  
Mark H. Wimmer, BSN ◽  
Kenneth Heffner, BSN ◽  
Michael Smithers, BSN ◽  
Richard Culley, BSN ◽  
Jennifer Coyner, PhD, CRNA ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Analysis Of Variance ◽  
Repeated Measures ◽  
Maximum Concentration ◽  
Life Support ◽  
Spontaneous Circulation ◽  
Control Group ◽  
Swine Model ◽  
Return Of Spontaneous Circulation ◽  
Significant Difference

Introduction: The American Heart Association (AHA) recommends intravenous (IV) or intraosseous (IO) vasopressin in Advanced Cardiac Life Support (ACLS). Obtaining IV access in hypovolemic cardiac arrest patients can be difficult, and IO access is often obtained in these life threatening situations. No studies have been conducted to determine the effects of humeral IO (HIO) access with vasopressin in the return of spontaneous circulation (ROSC). Our study compared the kinetics of vasopressin and ROSC with HIO with IV access in the hypovolemic swine model.Methods: Twenty-two Yorkshire swine were divided into three groups: HIO (n = 7), IV (n = 8), and a control group (n = 7). The IV and HIO group received vasopressin and cardiopulmonary resuscitation (CPR), while the control group received only CPR. All subjects were exsanguinated 31 percent of their blood volume, placed in cardiac arrest, and resuscitated per ACLS. Subjects that achieved ROSC were then monitored for 20 minutes. Blood samples (10 mL) collected at 0.5, 1, 1.5, 2, 2.5, 3, and 4 minutes after vasopressin injection and analyzed for maximum concentration (Cmax) and time to maximum concentration (Tmax). Data were analyzed using a multivariate analysis of variance (MANOVA) and a Fisher's Exact Test.Results: ROSC was achieved in every subject that received vasopressin via the HIO route. Data analysis using a MANOVA pairwise comparison revealed no difference between mean Cmax (p = 0.601) and Tmax (p = 0.771) of vasopressin administered IV versus HIO routes. Analysis of the mean serum concentrations at time intervals using a repeated measures analysis of variance found no difference (p 0.05). A Fisher's Exact Test revealed no difference in rate of ROSC between HIO and IV groups (p 0.05). Odds ratio determined that there was a 33 times higher chance of survival among HIO subjects versus control (CPR and Defibrillation; p = 0.03) and no difference in the survivability of the HIO or IV groups (p = 0.52). Conclusion: The data from this study strongly suggest that there is no significant difference in ROSC, time to ROSC, hemodynamics, or pharmacokinetics between HIO vasopressin and IV vasopressin. This research reinforces current AHA guidelines recommending the use of HIO route early over delaying care awaiting IV access.

Sign in / Sign up

Export Citation Format

Share Document