The Pharmacokinetics of Intraosseous Epinephrine during Cardiac Arrest in Swine


Name: Michael Loughren

Rank: LTC

Organization: The Geneva Foundation

Performance Site: Brooke Army Medical Center, San Antonio, TX; Army Graduate Program in Anesthesia Nursing (USAGPAN), San Antonio, TX

Year Published: 2011

Abstract Status: Project Completed


INTRODUCTION: When a patient is in cardiac arrest, rapid vascular access is essential. The American Heart Association recommends that 1 mg of epinephrine be given either intravenous (IV) or intraosseous (IO) for patients in cardiac arrest.  However, the investigators of the proposed study compared IO (sternal and tibial) to IV administration of epinephrine relative to maximum concentration (Cmax), area under the curve (AUC), a measure of overall exposure during the dosing interval, and time to maximum concentration (Tmax) in a swine cardiac arrest model. The Cmax and AUC were substantially reduced and the Tmax was increased in the both IO groups compared to the IV group. Therefore, the administration of 1 mg of epinephrine by IO routes may be ineffective and potentially result in loss of life. The practitioner may be unknowingly under resuscitating when using the IO device is used to administer epinephrine. The ResQPod is a device used in cardiac arrest that increases circulation.  The device may circulate enough blood so that the IO and IV administration of epinephrine during cardiac arrest results in an equivalent drug exposure.  AIMS:  1.To determine the equivalent epinephrine dose administered by IO (sternal and tibial) compared to 0.015 mg/ kg (1mg per 70 kg) IV dose in a cardiac arrest model. 2.To determine the extent to which CPR changes the kinetics of epinephrine administered IV and IO (sternal and tibial) compared to spontaneous circulation. 3.To determine the effects of the ResQPod on the serum concentration of epinephrine when 0.015 mg/ kg of epinephrine is administered by IV and IO (sternal and tibial) routes of administration.  DESIGN: The study is a prospective, experimental design. METHODS: Swine will be randomly assigned to one of 6 groups (n = 8 per group): Spontaneous Circulation; Arrest CPR no drugs; Arrest CPR with ResQPod with 0.015 mg/kg of epinephrine & 3 Arrest Groups CPR with epineprhine 0.015mg/kg; with 0.035 mg/kg; & with 0.072 mg/kg.  A MANOVA will be conducted to test for significance (α = .05) the difference between the three groups (Tibial IO, Sernal IO, and IV) on the response variables (Cmax, Tmax, AUC).  If significant difference exists, aTukey post-hoc will be performed to determine where the significance lies.

This study will clearly address several of the priorities of research as mandated by TSNRP: nursing competencies and practice, translating research into practice, and clinical excellence. This study will provide evidence to translate into practice. The results have potential to change practice. The aims and findings of this study directly impact military deployment health.


Final Report is available on NTRL: