Effects of tibial and humerus intraosseous and intravenous vasopressin in porcine cardiac arrest model

Adams, Timothy; Blouin, Dawn; Johnson, Don

doi:10.5055/ajdm.2016.0241

Cited by 19 publications

(8 citation statements)

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“…The investigators used data from similar, previous studies and calculated a large effect size of 0.6 14–19 . Using an α of 0.05, an effect size of 0.6, and a power of 0.80, we determined a sample size of 7 per group was needed.…”

Section: Methodsmentioning

confidence: 99%

“…The investigators used data from similar, previous studies and calculated a large effect size of 0.6. [14][15][16][17][18][19] Using an α of 0.05, an effect size of 0.6, and a power of 0.80, we determined a sample size of 7 per group was needed. Power analysis was performed using G*Power 3.1 for Windows (Heinrich Heine University, Dusseldorf, Germany).…”

Section: Sample Size Estimationmentioning

confidence: 99%

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Endotracheal Administered Epinephrine Is Effective in Return of Spontaneous Circulation Within a Pediatric Swine Hypovolemic Cardiac Arrest Model

et al. 2020

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Objective: Early administration of epinephrine increases the incidence of return of spontaneous circulation (ROSC) and improves outcomes among pediatric cardiac arrest victims. Rapid endotracheal (ET) intubation can facilitate early administration of epinephrine to pediatric victims. To date, no studies have evaluated the use of ETepinephrine in a pediatric hypovolemic cardiac arrest model to determine the incidence of ROSC.Methods: This prospective, experimental study evaluated the pharmacokinetics and/or incidence of ROSC following ET administered epinephrine and compared it to these experimental groups: intravenous (IV) administered epinephrine, cardiopulmonary resuscitation only (CPR), and CPR + defibrillation (CPR + Defib).Results: Endotracheal administered epinephrine, at the Pediatric Advanced Life Support (PALS) recommended dose, was not significantly different than IV administered epinephrine in maximum plasma concentrations, time to maximum plasma concentration, area under the curve, or ROSC, or mean plasma concentrations at various time points (P > 0.05). The odds of ROSC in the ET group were 2.4 times greater than the IV group. The onset to ROSC in the ET group was significantly shorter than the IV group (P < 0.0001).Conclusions: These data support that ET epinephrine administration remains an alternative to IV administered epinephrine and faster at restoring ROSC among pediatric hypovolemic cardiac arrest victims in the acute setting when an endotracheal tube is present. Although further research is required to determine long-term outcomes of high-dose ET epinephrine administration, these data reinforce the therapeutic potential of ET administration of epinephrine to restore ROSC before IV access.

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Section: Methodsmentioning

confidence: 99%

Section: Sample Size Estimationmentioning

confidence: 99%

Endotracheal Administered Epinephrine Is Effective in Return of Spontaneous Circulation Within a Pediatric Swine Hypovolemic Cardiac Arrest Model

et al. 2020

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show abstract

“…The investigators used data from similar, previous studies and calculated a large effect size of 0.6 16–21 . Using an α of 0.05, an effect size of 0.6, and a power of 0.80, we determined a sample size of 7 per group was needed.…”

Section: Methodsmentioning

confidence: 99%

“…The investigators used data from similar, previous studies and calculated a large effect size of 0.6. [16][17][18][19][20][21] Using an α of 0.05, an effect size of 0.6, and a power of 0.80, we determined a sample size of 7 per group was needed. Power analysis was performed using G*Power 3.1 for Windows (Heinrich Heine University, Dusseldorf, Germany).…”

Section: Sample Size Estimationmentioning

confidence: 99%

Tibial Intraosseous Administration of Epinephrine Is Effective in Restoring Return of Spontaneous Circulation in a Pediatric Normovolemic But Not Hypovolemic Cardiac Arrest Model

et al. 2020

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ObjectiveWe compared the efficacy of tibial intraosseous (TIO) administration of epinephrine in a pediatric normovolemic versus hypovolemic cardiac arrest model to determine the incidence of return of spontaneous circulation (ROSC) and plasma epinephrine concentrations over time.MethodsThis experimental study evaluated the pharmacokinetics of epinephrine and/or incidence of ROSC after TIO administration in either a normovolemic or hypovolemic pediatric swine model.ResultsAll subjects in the TIO normovolemia cardiac arrest group experienced ROSC after TIO administration of epinephrine. In contrast, subjects experiencing hypovolemia and cardiac arrest were significantly less likely to experience ROSC when epinephrine was administered TIO versus intravenous (TIO hypovolemia: 14% [1/7] vs IV hypovolemia: 71% [5/7]; P = 0.031). The TIO hypovolemia group exhibited significantly lower plasma epinephrine concentrations versus IV hypovolemia at 60, 90, 120, and 150 seconds (P < 0.05). Although the maximum concentration of plasma epinephrine was similar, the TIO hypovolemia group exhibited significantly slower time to maximum concentration times versus TIO normovolemia subjects (P = 0.004).ConclusionsTibial intraosseous administration of epinephrine reliably facilitated ROSC among normovolemic cardiac arrest pediatric patients, which is consistent with published reports. However, TIO administration of epinephrine was ineffective in restoring ROSC among subjects experiencing hypovolemia and cardiac arrest. Tibial intraosseous–administered epinephrine during hypovolemia and cardiac arrest may have resulted in a potential sequestration of epinephrine in the tibia. Central or peripheral intravascular access attempts should not be abandoned after successful TIO placement in the resuscitation of patients experiencing concurrent hypovolemia and cardiac arrest.

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“…The investigators used data from similar, previous studies and calculated a large effect size of 0.6 (Adams, Blouin, & Johnson, 2016;Fulkerson et al, 2016;Johnson et al, 2015;Johnson et al, 2016;Loughren et al, 2014;Wong et al, 2016). Using an α of 0.05, an effect size of 0.6, and a power of .80, we determined a sample size of 14 (N = 7 per group) was needed.…”

Section: Sample Size Estimationmentioning

confidence: 99%

Effects of Endotracheal Administration of Epinephrine in Cardiac Arrest of Adult and Pediatric Swine

Kertes¹,

Fillman²,

Krawczyk³

et al. 2019

MSHP

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BACKGROUND: Few studies have investigated the effects of hypovolemia on area under the curve (AUC) and the return of spontaneous circulation (ROSC) comparing adults and children in cardiac arrest.AIMS: To compare the epinephrine endotracheal (ET) administration relative to AUC, rate, time to, and odds of achieving ROSC between hypovolemic adult and pediatric cardiac arrest models.METHODS: This was an experimental study using male Adult ET and Pediatric ET swine. Pediatric ET pigs (N=7) weighed 20-30 kg representing the average weight for a child between 5 and 6 years of age. Adult ET pigs (N=7) weighed 60 to 80 kg. All were exsanguinated 35% of their blood volume. Swine were put into arrest for 2 minutes. Cardiopulmonary resuscitation (CPR) was initiated for 2 minutes; epinephrine was then administered. Blood samples were collected over 5 minutes. RESULTS: No significant difference occurred in AUC between the groups (p > 0.05). The Pediatric ET group had higher rates of ROSC and a shorter time to ROSC (p < 0.05). Pediatric ET group had a 15 times greater odds of achieving ROSC compared to the Adult ET group. CONCLUSION: Based on the results of this study, we recommend epinephrine administration via ET within the pediatric arrest model, but not for the adult.

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Effects of tibial and humerus intraosseous and intravenous vasopressin in porcine cardiac arrest model

Abstract: The TIO and HIO provide rapid and reliable access to administer life-saving medications during cardiac arrest.

Cited by 19 publications

References 0 publications

Endotracheal Administered Epinephrine Is Effective in Return of Spontaneous Circulation Within a Pediatric Swine Hypovolemic Cardiac Arrest Model

Endotracheal Administered Epinephrine Is Effective in Return of Spontaneous Circulation Within a Pediatric Swine Hypovolemic Cardiac Arrest Model

Tibial Intraosseous Administration of Epinephrine Is Effective in Restoring Return of Spontaneous Circulation in a Pediatric Normovolemic But Not Hypovolemic Cardiac Arrest Model

Effects of Endotracheal Administration of Epinephrine in Cardiac Arrest of Adult and Pediatric Swine

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