Research Article
Volume 6 Issue 4 - 2020
Tibial Intraosseous and Intravenous Administration of Epinephrine in Normovolemic and Hypovolemic Cardiac Arrest
COL Denise Beaumont1, LTC Michelle Johnson2, Julie G Hensler3, Dawn Blouin4, Joseph O’Sullivan5 and Don Johnson6*
1Director, United States Army Graduate Program San Antonio, Texas, USA
2Executive Officer, United States Army Graduate Program, San Antonio, Texas, USA
3Professor, United States Army Graduate Program, San Antonio, Texas, USA
4Research Assistant, United States Army Graduate Program, San Antonio, Texas, USA
5Research Scientist, Geneva Foundation, Tacoma, Washington, USA
6Professor and Director of Research, United States Army Graduate Program, San Antonio, Texas, USA
*Corresponding Author: Don Johnson, Professor and Director of Research, United States Army Graduate Program, San Antonio, Texas, USA.
Received: February 21, 2020; Published: March 16, 2020


Introduction: Cardiac arrests can be classified as either hypovolemic or normovolemic causes. Hemorrhage is the major cause of hypovolemic cardiac arrest. Bleeding can lead to shock with subsequent cardiac arrest. Causes of cardiac arrest in normovolemic scenarios are related to cardiovascular diseases but can include myocardial infarct, blunt trauma, drowning and electrocution. Guidelines for intervention include intravenous (IV) or intraosseous epinephrine administration with repeated dosing every 3 - 5 minutes for patients in arrest. This guideline is based on expert opinion and very little research. No one has investigated the area under the curve (AUC), which is the body’s exposure to a drug, or return of spontaneous circulation (ROSC) with tibial intraosseous (TIO) and IV administration of epinephrine in hypovolemic and normovolemic cardiac arrest models. 

Aim: Aim of this study were to compare AUC, frequency and odds of ROSC when epinephrine was administered by the TIO and IV routes in hypovolemic and normovolemic models of cardiac arrest. 

Methods: This was a prospective, experimental study. 28 adult swine were randomly assigned to 4 groups: TIO Normovolemic Group (TIONG), TIO Hypovolemic Group (TIOHG), IV Normovolemic Group (IVNG) and the IV Hypovolemic Group (IVHG). Pigs were anesthetized. 35% of the pigs’ blood volume was exsanguinated in the hypovolemic groups. Pigs were in arrest for 2 minutes; cardiopulmonary resuscitation (CPR) was initiated for 2 minutes. Epinephrine (1 mg) was then administered by either the TIO or IV routes and repeated every 4 minutes or until ROSC. Blood samples were collected over 5 minutes. The serum concentration of epinephrine was determined using high-performance liquid chromatography. Defibrillation was initiated 3 minutes post arrest and repeated every 2 minutes. 

Results and Discussion: A Chi-Square indicated that no differences existed among the groups relative to ROSC (p > 0.05). Odds of ROSC were higher for the TIONG than other groups. The AUC was higher in the TIONHG vs. the IVHG and IVNG; The IVNG was higher than the TIOHG (p < 0.05). 

Conclusion: We were able to insert a TIO device in less than 10 seconds and CPR did not have to be interrupted. ROSC was either the same or better in the TIO groups. Because time is of essence to administer epinephrine in a cardiac arrest, perhaps the TIO route should be considered the first-line intervention. This study adds needed empirical data for guidelines for caring for patients in cardiac arrests. 

Keywords: Cardiac Arrest; Epinephrine; Shock; Tibial Intraosseous; Area under the Curve


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Citation: Don Johnson., et al. “Tibial Intraosseous and Intravenous Administration of Epinephrine in Normovolemic and Hypovolemic Cardiac Arrest”. EC Anaesthesia 6.4 (2020): 10-17.

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