Pharmacokinetic effects of endotracheal, intraosseous, and intravenous epinephrine in a swine model of traumatic cardiac arrest
| Autor: | Arthur D. Johnson, Cory C. Herzog, Matthew S. Moore, Joseph O'Sullivan, James Burgert, Japeth W. Rauch, Wayne J. Blalock, Brent C. Duffield, Brian P. Albright, Katelyn S. Dempster |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Male
Resuscitation Epinephrine Defibrillation medicine.medical_treatment Sus scrofa Cmax Traumatic cardiac arrest Blood volume Return of spontaneous circulation Random Allocation 03 medical and health sciences 0302 clinical medicine Pharmacokinetics Intubation Intratracheal Animals Medicine Prospective Studies Sympathomimetics Infusions Intravenous business.industry 030208 emergency & critical care medicine General Medicine Infusions Intraosseous medicine.disease Heart Arrest Anesthesia Emergency Medicine Wounds and Injuries business medicine.drug |
| Zdroj: | The American Journal of Emergency Medicine. 37:2043-2050 |
| ISSN: | 0735-6757 |
| DOI: | 10.1016/j.ajem.2019.02.035 |
| Popis: | Introduction Limited prospective data exist regarding epinephrine's controversial role in managing traumatic cardiac arrest (TCA). This study compared the maximum concentration (Cmax), time to maximum concentration (Tmax), plasma concentration over time, return of spontaneous circulation (ROSC), time to ROSC, and odds of ROSC of epinephrine administered by the endotracheal (ETT), intraosseous (IO), and intravenous (IV) routes in a swine TCA model. Methods Forty-nine Yorkshire-cross swine were assigned to seven groups: ETT, tibial IO (TIO), sternal IO (SIO), humeral IO (HIO), IV, CPR with defibrillation (CPRD), and CPR only. Swine were exsanguinated 31% of their blood volume and cardiac arrest induced. Chest compressions began 2 min post-arrest. At 4 min post-arrest, 1 mg epinephrine was administered, and blood specimens collected over 4 min. Resuscitation continued until ROSC or 30 min elapsed. Results The Cmax of IV epinephrine was significantly higher than the TIO group (P = 0.049). No other differences in Cmax, Tmax, ROSC, and time to ROSC existed between the epinephrine groups (P > 0.05). Epinephrine levels were detectable in two of seven ETT swine. No significant difference in ROSC existed between the epinephrine groups and CPRD group (P > 0.05). Significant differences in ROSC existed between all groups and the CPR only group (P Conclusions The pharmacokinetics of IV, HIO, and SIO epinephrine were comparable. Endotracheal epinephrine absorption was highly variable and unreliable compared to IV and IO epinephrine. Epinephrine appeared to have a lesser role than volume replacement in resuscitating TCA. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect