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Authors:
Denise Beaumont, Michelle Johnson, Julie G. Hensler, Dawn Blouin, Joe O’Sullivan, Don Johnson, USA
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Abstract:
Introduction: Cardiac arrests are common with over 570,000
reported adult out-of-hospital cardiac arrest just in the United States.
Objective: The aim of this study was to compare tibial
intraosseous (TIO), intravenous (IV), and endotracheal (ET) administration of
epinephrine relative to area under the curve (AUC), frequency, and odds of
spontaneous return of circulation (ROSC) in a cardiac arrest hypovolemic model.
Design: Prospective, experimental, blinded study.
Participants: Adult Yorkshire Swine (n = 7 per group).
Methods: Swine were
anesthetized, and each had an IV, ET tube, or TIO inserted. They were
exsanguinated 35% of their blood volume and then placed into arrest. After 2
minutes, cardiopulmonary resuscitation was initiated. After another 2 minutes,
epinephrine (1 mg for IV and TIO groups; 2 mg for ET group) was administered.
All subjects were defibrillated every 2 minutes. Blood samples were collected
over 5 minutes and analyzed using high performance mass spectrometry. AUC was
then calculated.
Main Outcome Measures:
AUC, frequency, and odds of ROSC.
Results: AUC in the TIO and ET Groups were significantly
lower than the IV Group (p < 0.05). ROSC occurred in 4 out of 7 for both the
IV and TIO Groups and 2 out of 7 for the ET Group. Odds of ROSC were 3.3 times
greater for both IV and TIO groups vs. the ET group.
Conclusions: Chances of survival from
arrest are decreased by 9% for every minute delay in administering epinephrine.
TIO insertion takes less than 10 seconds and is just as effective as IV.
Valuable time can be saved by using this route. ET administration is not as
reliable.
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