Effects of Routes of Administration of Vasopressing in a Cardiac Arrest Model

Introduction: When a patient is in cardiac arrest, rapid vascular access is essential. The American Heart Association recommends that 1 mg of epinephrine or 40 units of vasopressin be administered either intravenous (IV), endotracheal (ET) or intraosseous (IO) for patients in cardiac arrest. However, the investigators of this proposed study recently found that the tibial IO administration of epinephrine did not result in the equivalent plasma levels as IV administration during cardiopulmonary resuscitation (CPR): the IV levels were five times greater than tibial IO concentration. Specifically, the maximum concentration (Cmax) of epinephrine was reduced, and the time required to reach maximum concentration (Tmax) was increased when the drug was administered by IO route. There are limited data regarding the appropriate dose of vasopressin when administered by the ET and IO route. The ResQPod is a device used in cardiac arrest that increases circulation. The device may circulate enough blood so that the IO, ET, and IV administration of vasopressin during cardiac arrest results in an equivalent drug exposure or there may have to be a dose adjustment. 

Aims:  1)To determine the kinetics of vasopressin when administered by IO (sternal, humerus, tibial) and ET routes compared to IV routes in a cardiac arrest scenario. 2)To determine the effects of IO and ET routes of administration of vasopressin on return of spontaneous circulation (ROSC). 3)To determine the effects of doubling the dose of vasopressin by tibial IO and ET routes on the kinetics of vasopressin during cardiac arrest and on ROSC. 4) To determine the effects of the ResQPod on the kinetics of vasopressin and ROSC when administered by tibial IO and ET routes. DESIGN: The study is a prospective, experimental design. 

Methods: Eight swine will be assigned to 1 of 12 groups: IV, IO Sternal, IO Tibia, IO humerus, ET,  Double Dose IO Tibia, Double Dose ET, IO Tibia with ResQPod, ET ResQPod, IV ResQPod, CPR No drug, CPR Defibrillation No Drug.  ANAYSIS A chi-square and a MANOVA with a post-hoc Tukey will be used to test for a significance (α = .05) difference between the groups on the outcome variables:  kinetics and ROSC.   

The purpose of this study is to investigate time-sensitive questions regarding military nursing practice and the administration of life-saving vasopressin to patients in cardiac arrest. This study addresses the priorities of TSNRP, specifically, interventions that improve patient outcomes by saving lives and ultimately providing for mission ready personnel. This study will provide evidence-based data for the route of administration of vasopressin.

Final Report is available on NTRL: https://ntrl.ntis.gov/NTRL/dashboard/searchResults/titleDetail/PB2018101...