STERNAL INTRAOSSEOUS EPINEPHRINE ADMINISTRATION IN A HYPOVOLEMIC PEDIATRIC CARDIAC ARREST MODEL

Don Johnson PhD*, Julie G. Hensler, PhD, Dawn Blouin, BS, COL Young John Yauger, CRNA, PhD, MAJ Benjamin C. Dixon, USA, MPH, DVM, DACLAM, DACVPM and Joseph O’Sullivan, CRNA, PhD

ABSTRACT

Introduction: The purposes were to compare return of spontaneous circulation (ROSC), the maximum concentration (Cmax), time to maximum concentration (Tmax), mean concentration (MC), and area under the curve (AUC) of epinephrine administered by the sternal intraosseous (SIO) and the intravenous (IV) routes of in a pediatric, hypovolemic cardiac arrest model. Procedures: Yorkshire (Sus scrofa) Swine weighing 20-30 kg representing 9-year-old children were randomly assigned to SIO (n = 9); IV (n = 7); CPR + defibrillation (CPR+defib) (n = 7); CPR-Only (n = 5) groups. Thirty-five percent of their blood volume was withdrawn. Pigs were then placed in arrest for 2 min; CPR was started for 2 min; epinephrine 0.01 mg/kg was then administered to the SIO and IV groups. Blood samples were collected over 5 minutes. After sample collection, epinephrine was continued every 4 min, and defibrillation was performed every 2 mins except for the CPR-Only Group that just received CPR. Results: The frequency of ROSC was significantly higher in the SIO (9 out of 9) group than the IV (5 out of 7); the CPR+defib (1 out of 7), and CPR-Only groups (0 out of 5) (p < 0.05). No significant difference occurred between the time to ROSC between the groups (p = 0.419). SIO had an 8.6 times greater chance of ROSC compared to the IV group. Overall, the IV group had higher MC over time, longer Tmax, and higher AUC than the SIO group (p < 0.05). Conclusion: The SIO group was highly effective and should be considered as a first-line intervention for pediatric hypovolemic patients in cardiac arrest.

Keywords: Pediatric CPR; Hypovolemic shock; Hemorrhage; Cardiac Arrest; Sternal Intraosseous Epinephrine.