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Original research
Effects of humeral intraosseous epinephrine in a pediatric hypovolemic cardiac arrest porcine model
  1. Michael James Neill1,
  2. James M Burgert2,
  3. Dawn Blouin3,
  4. Benjamin Tigges1,
  5. Kari Rodden1,
  6. Rachel Roberts1,
  7. Phillip Anderson1,
  8. Travis Hallquist1,
  9. John Navarro1,
  10. Joseph O'Sullivan1,
  11. Don Johnson1
  1. 1US Army Graduate Program in Anesthesia Nursing, US Army Medical Department, Fort Sam Houston, Texas, USA
  2. 2Department of Continuing EducationEvidence-based Healthcare Program, University of Oxford Kellogg College, Oxford, Oxfordshire, UK
  3. 3Geneva Foundation, Tacoma, Washington, USA
  1. Correspondence to Dr Michael James Neill; michael.j.neill.mil{at}mail.mil

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). 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.

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

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/tsaco-2019-000372

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    Footnotes

    • Contributors MJN, JMB, JO’S and DJ conceived and implemented study. In addition, analyzed the data, interpreted the results and wrote the manuscript. DB, BT, KR, RR, PA, TH and JN carried out the experiments under the direct supervision of MJN, JO’S and DJ. DB, BT, KR, RR, PA, TH and JN contributed to the interpretation of the data and wrote sections of the manuscript.

    • Funding This study was funded by TriService Nursing Research Program (N17-B06).

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The Naval Medical Research Unit, San Antonio Institutional Animal Care and Use Committee (IACUC) approved the research protocol to be conducted in their laboratory setting.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.