Open Access Open Access  Restricted Access Subscription Access

The effects of tibial intraosseous versus intravenous amiodarone administration in a hypovolemic cardiac arrest procine model

Kathryn Hampton, BSN, Eric Wang, BSN, Jerome Ivan Argame, BSN, Tom Bateman, BSN, William Craig, DNP, CRNA, Don Johnson, PhD

Abstract


Objective: This study compared the effects of amiodarone via tibial intraosseous (TIO) and intravenous (IV) routes on return of spontaneous circulation (ROSC), time to ROSC, maximum drug concentration (Cmax), time to maximum concentration (Tmax), and mean concentrations over time in a hypovolemic cardiac arrest model.

Design: Prospective, between subjects, randomized experimental design.

Setting: TriService Research Facility.

Subjects: Yorkshire-cross swine (n = 28).

Intervention: Swine were anesthetized and placed into cardiac arrest. After 2 minutes, cardiopulmonary resuscitation (CPR) was initiated. After an additional 2 minute, 300 mg of amiodarone were administered via the TIO or the IV route. Blood samples were collected over 5 minutes. The plasma concentrations were analyzed using high-performance liquid chromatography tandem mass spectrometry.

Main Outcome Measurements: ROSC, time to ROSC, Cmax, Tmax, and mean concentrations over time.

Results: A multivariate analysis of variance indicated that there were no significant differences in the TIO and IV groups in ROSC (p = 0.515), time to ROSC (p = 0.300), Cmax (p = 0.291), or Tmax (p = 0.475). The mean Cmax of the TIO group was 56,292 ± 11,504 ng/mL compared to 74,258 ± 11,504 ng/mL for the IV group. The Tmax for TIO and IV groups were 120 ± 25 and 94 ± 25, respectively. A repeated measures analysis of variance indicated that there were no significant differences between the groups relative to concentrations over time (p > 0.05).

Conclusion: The TIO provides rapid and reliable access to administer lifesaving medications during cardiac arrest.


Keywords


amiodarone, intraosseous, return of spontaneous circulation, pharmacokinetics, resuscitation, hemorrhage

Full Text:

PDF

References


Mozaffarian D, Benjamin EJ, Go AS, et al.: Heart disease and stroke statistics—2015 update: A report from the American Heart Association. Circulation. 2015; 131(4): e29.

Kuisma M, Alaspää A: Out-of-hospital cardiac arrests of noncardiac origin. Epidemiology and outcome. Eur Heart J. 1997; 18(7): 1122-1128.

Kauvar DS, Lefering R, Wade CE: Impact of hemorrhage on trauma outcome: An overview of epidemiology, clinical presentations, and therapeutic considerations. J Trauma. 2006; 60(6)(suppl): S3-S11.

Neumar RW, Otto CW, Link MS, et al.: Part 8: Adult advanced cardiovascular life support: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2010; 122(18)(suppl 3): S729-S767.

Anson JA: Vascular access in resuscitation: Is there a role for the intraosseous route? Anesthesiology. 2014; 120(4): 1015-1031.

Burgert J, Gegel B, Loughren M, et al.: Comparison of tibial intraosseous, sternal intraosseous, and intravenous routes of administration on pharmacokinetics of epinephrine during cardiac arrest: A pilot study. AANA J. 2012; 80(4)(suppl): S6-S10.

Harris M, Balog R, Devries G: What is the evidence of utility for intraosseous blood transfusion in damage-control resuscitation? Journal Trauma Acute Care Surg. 2013; 75(5): 904-906.

Lewis PH, Wright CR: Saving the critically injured trauma patient: A retrospective analysis of 1000 uses of intraosseous access. Scand J Trauma Resusc Emerg Med. 2015; 23(suppl 2): A15-A15.

Reades R, Studnek JR, Vandeventer S, et al.: Intraosseous versus intravenous vascular access during out-of-hospital cardiac arrest: A randomized controlled trial. Ann Emerg Med. 2011; 58(6): 509-516.

Kudenchuk PJ, Cobb LA, Copass MK, et al.: Amiodarone for resuscitation after out-of-hospital cardiac arrest due to ventricular fibrillation. N Engl J Med. 1999; 341(12): 871-878.

Dorian P, Cass D, Schwartz B, et al.: Amiodarone as compared with lidocaine for shock-resistant ventricular fibrillation. N Engl J Med. 2002; 346(12): 884-890.

Day MW: Intraosseous devices for intravascular access in adult trauma patients. Crit Care Nurse. 2011; 31(2): 76-89.

Gazin N, Auger H, Jabre P, et al.: Efficacy and safety of the EZ-IO intraosseous device: Out-of-hospital implementation of a management algorithm for difficult vascular access. Resuscitation. 2011; 82(1): 126-129.

Von Hoff DD, Kuhn JG, Burris HA 3rd, et al.: Does intraosseous equal intravenous? A pharmacokinetic study. Am J Emerg Med. 2008; 26(1): 31-38.

Fulkerson J, Lowe R, Anderson T, et al.: Effects of intraosseous tibial vs. intravenous vasopressin in a hypovolemic cardiac arrest model. West J Emerg Med. 2016; 17(2): 222-228.

Johnson D, Garcia-Blanco J, Burgert J, et al.: Effects of humeral intraosseous versus intravenous epinephrine on pharmacokinetics and return of spontaneous circulation in a porcine cardiac arrest model: A randomized control trial. Ann Med Surg. 2015; 4(3): 306-310.

Loughren M, Banks S, Naluan C, et al.: Onset and duration of intravenous and intraosseous rocuronium in swine. West J Emerg Med. 2014; 15(2): 241-245.

Yost J, Baldwin P, Bellenger S, et al.: The pharmacokinetics of intraosseous atropine in hypovolemic swine. Am J Disaster Med. 2015; 10(3): 217-222.

Blebea JS, Houseni M, Torigian DA, et al.: Structural and functional imaging of normal bone marrow and evaluation of its age-related changes. Semin Nucl Med. 2007; 37(3): 185-194.

Burgert JM, Johnson AD, Garcia-Blanco J, et al.: The effects of proximal and distal routes of intraosseous epinephrine administration on short-term resuscitative outcome measures in an adult swine model of ventricular fibrillation: a randomized controlled study. Am J Emerg Med. 2016; 34(1): 49-53.

Hoskins SL, do Nascimento P Jr, Lima RM, et al.: Pharmacokinetics of intraosseous and central venous drug delivery during cardiopulmonary resuscitation. Resuscitation. 2012; 83(1): 107-112.

Wenzel V, Lindner KH, Augenstein S, et al.: Intraosseous vasopressin improves coronary perfusion pressure rapidly during cardiopulmonary resuscitation in pigs. Crit Care Med. 1999; 27(8): 1565-1569.

Voelckel WG, Lurie KG, McKnite S, et al.: Effects of epinephrine and vasopressin in a piglet model of prolonged ventricular fibrillation and cardiopulmonary resuscitation. Crit Care Med. 2002; 30(5): 957-962.

CoT ACoS: Advanced Trauma Life Support for Doctors, Student Course Manual. 9th ed. Chicago, IL: American College of Surgeons, 2012.

Adams PC, Holt DW, Storey GC, et al.: Amiodarone and its desethyl metabolite: Tissue distribution and morphologic changes during long-term therapy. Circulation. 1985; 72(5):1064-1075.

Connolly SJ: Evidence-based analysis of amiodarone efficacy and safety. Circulation. 1999; 100(19): 2025-2034.

Karlis G, Iacovidou N, Lelovas P, et al.: Effects of early amiodarone administration during and immediately after cardiopulmonary resuscitation in a swine model. Acta Anaesthesiol Scand. 2014; 58(1): 114-122.

Andersen LW, Kurth T, Chase M, et al.: Early administration of epinephrine (adrenaline) in patients with cardiac arrest with initial shockable rhythm in hospital: Propensity score matched analysis. BMJ. 2016; 353: i1577.

Stroumpoulis K, Xanthos T, Rokas G, et al.: Vasopressin and epinephrine in the treatment of cardiac arrest: An experimental study. Crit Care. 2008; 12(2): R40-R40.

Deakin CD, Nolan JP, Soar J, et al.: European Resuscitation Council guidelines for resuscitation 2010 section 4. Adult advanced life support. Resuscitation. 2010; 81(10): 1305-1352.

Link MS, Berkow LC, Kudenchuk PJ, et al.: Part 7: Adult advanced cardiovascular life support: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132(18) (suppl 2): S444-S464.

Hazinski MF, Nolan JP, Aickin R, et al.: Part 1: Executive summary: 2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation. 2015; 132(16)(suppl 1): S2-S39.

Callaway CW, Soar J, Aibiki M, et al.: Part 4: Advanced life support: 2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation. 2015; 132(16)(suppl 1): S84-S145.

Hannon JP, Bossone CA, Wade CE: Normal physiological values for conscious pigs used in biomedical research. Lab Animal Sci. 1990; 40(3): 293-298.

Swindle MM, Makin A, Herron AJ, et al.: Swine as models in biomedical research and toxicology testing. Vet Pathol. 2012; 49(2): 344-356.

Paquette S, Gordon C, Bradtmiller B: Anthropometric Survey (ANSUR) II Pilot Study: Methods and Summary Statistics. Natick, MA: U.S. Army Natick Soldier Research Development and Engineering Center, 2009: 74-75.

Johnson D, Dial J, Ard J, et al.: Effects of intraosseous and intravenous administration of Hextend® on time of administration and hemodynamics in a Swine model. J Spec Oper Med. 2014; 14(1): 79-85.

Butler FK, Holcomb JB, Schreiber MA, et al.: Fluid resuscitation for hemorrhagic shock in Tactical Combat Casualty Care: TCCC guidelines change 14-01 - 2 June 2014. J Spec Oper Med. 2014; 14(3): 13-38.

Martini WZ, Dubick MA, Blackbourne LH: Comparisons of Lactated Ringer's and Hextend resuscitation on hemodynamics and coagulation following femur injury and severe hemorrhage in pigs. J Trauma Acute Care Surg. 2013; 74(3): 732-739.

Todd SR, Malinoski D, Muller PJ, et al.: Hextend attenuates hypercoagulability after severe liver injury in swine. J Trauma. 2005; 59(3): 589-593.

Liu L-M, Ward JA, Dubick MA: Effects of crystalloid and colloid resuscitation on hemorrhage-induced vascular hyporesponsiveness to norepinephrine in the rat. J Trauma. 2003; 54(5)(suppl): S159-S168.

Nielsen VG: Resuscitation with Hextend decreases endogenous circulating heparin activity and accelerates clot initiation after hemorrhage in the rabbit. Anesthesia and analgesia. 2001; 93(5): 1106-1110.

Ngo AS-Y, Oh JJ, Chen Y, et al.: Intraosseous vascular access in adults using the EZ-IO in an emergency department. Int J Emerg Med. 2009; 2(3): 155-160.




DOI: http://dx.doi.org/10.5055/ajdm.2016.0247

Refbacks

  • There are currently no refbacks.