Epinephrine Administration in a Pediatric Swine Hypovolemic Cardiac Arrest Model

This study will determine the effects of administration of epinephrine by intraosseous (IO), intravenous (IV), and by endotracheal (ET) routes in a hypovolemic, pediatric model of cardiac arrest. The outcome variables are mean concentration over time, concentration maximum (Cmax), time to maximum concentration (Tmax), Area under the curve (AUC) of epinephrine, and return of spontaneous circulation (ROSC). Yorkshire Cross Swine (7 per group, total 49 + 7 for model development = 56 subjects) weighing between 20 and 30 kg will be used to simulate children between 5 and 6 years of age. The groups will consist of Sternal IO, Tibia IO, Humerus IO, IV, Endotracheal, and two control groups (CPR only and CPR + defibrillation). All swine will be sedated, anesthetized, and placed on mechanical ventilation with monitors applied. Arterial and venous catheters will be inserted and the appropriate IO device. We will then exsanguinate 35% (Class III) of the blood volume. After 5 minutes of stabilization, we will place the swine into cardiac arrest by direct electrical current. After 2 minutes, CPR will be initiated and continued for 2 minutes. Epinephrine (0.01 mg/kg of 1:10,000) will be administered by IO or IV route depending on group assignment. The ET group will receive 0.1 mg/kg of 1:1000 concentration. One baseline and samples at 30, 60, 90, 120, 150, 180, 240, and 300 seconds will be collected. Albumin will then be administered. After the samples are collected, we will 5 % solution of albumin at 10ml/kg and
continue CPR and defibrillate at 2 J/kg and repeat at 4J/kg every 2 minutes or until ROSC. Epinephrine will be repeated every 4 minutes and defibrillation will continue every 2 minutes for 30 minutes or until ROSC occurs. This study will produce the data to determine the effectiveness of different routes of administration of epinephrine.
RELEVANCE
The number one cause of death among children is trauma, subsequent hemorrhage, and cardiac arrest. Based on limited evidence, the American Heart Association recommends epinephrine be administered by IV and if not accessible IO or ET routes used. No research has investigated the variables addressed in proposed study. This study will provide evidence for making clinical decisions relative to a pediatric, hypovolemic mode.