Hostname: page-component-76fb5796d-25wd4 Total loading time: 0 Render date: 2024-04-25T09:54:04.763Z Has data issue: false hasContentIssue false
  • English
  • Français

The Resuscitative and Pharmacokinetic Effects of Humeral Intraosseous Vasopressin in a Swine Model of Ventricular Fibrillation

Published online by Cambridge University Press:  08 March 2017

James M. Burgert Open the ORCID record for James M. Burgert [Opens in a new window] ,
Arthur D. Johnson ,
Jose Garcia-Blanco ,
Lawrence V. Fulton  and
Michael J. Loughren
James M. Burgert*
Affiliation:
The Geneva Foundation for Military Medical Research, Tacoma, WashingtonUSA College of Health Sciences, Midwestern University, Glendale, ArizonaUSA
Arthur D. Johnson
Affiliation:
The Geneva Foundation for Military Medical Research, Tacoma, WashingtonUSA United States Army Medical Department Center and School, Northeastern University, Fort Sam Houston, TexasUSA
Jose Garcia-Blanco
Affiliation:
The Geneva Foundation for Military Medical Research, Tacoma, WashingtonUSA
Lawrence V. Fulton
Affiliation:
Rawls College of Business & Center for Health Innovation, Education & Research, Texas Tech University, Lubbock, TexasUSA
Michael J. Loughren
Affiliation:
Department of Anesthesia, Madigan Army Medical Center, Fort Lewis, WashingtonUSA
*
Correspondence: James M. Burgert, DNAP Midwestern University College of Health Sciences 19555 N. 59th Ave. Glendale, Arizona 85308 USA E-mail: james.burgert@alumni.bcm.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

The American Heart Association (AHA; Dallas, Texas USA) and European Resuscitation Council (Niel, Belgium) cardiac arrest (CA) guidelines recommend the intraosseous (IO) route when intravenous (IV) access cannot be obtained. Vasopressin has been used as an alternative to epinephrine to treat ventricular fibrillation (VF).

Hypothesis/Problem

Limited data exist on the pharmacokinetics and resuscitative effects of vasopressin administered by the humeral IO (HIO) route for treatment of VF. The purpose of this study was to evaluate the effects of HIO and IV vasopressin, on the occurrence, odds, and time of return of spontaneous circulation (ROSC) and pharmacokinetic measures in a swine model of VF.

Methods

Twenty-seven Yorkshire-cross swine (60 to 80 kg) were assigned randomly to three groups: HIO (n=9), IV (n=9), and a control group (n=9). Ventricular fibrillation was induced and untreated for two minutes. Chest compressions began at two minutes post-arrest and vasopressin (40 U) administered at four minutes post-arrest. Serial blood specimens were collected for four minutes, then the swine were resuscitated until ROSC or 29 post-arrest minutes elapsed.

Results

Fisher’s Exact test determined ROSC was significantly higher in the HIO 5/7 (71.5%) and IV 8/11 (72.7%) groups compared to the control 0/9 (0.0%; P=.001). Odds ratios of ROSC indicated no significant difference between the treatment groups (P=.68) but significant differences between the HIO and control, and the IV and control groups (P=.03 and .01, respectively). Analysis of Variance (ANOVA) indicated the mean time to ROSC for HIO and IV was 621.20 seconds (SD=204.21 seconds) and 554.50 seconds (SD=213.96 seconds), respectively, with no significant difference between the groups (U=11; P=.22). Multivariate Analysis of Variance (MANOVA) revealed the maximum plasma concentration (Cmax) and time to maximum concentration (Tmax) of vasopressin in the HIO and IV groups was 71753.9 pg/mL (SD=26744.58 pg/mL) and 61853.7 pg/mL (SD=22745.04 pg/mL); 111.42 seconds (SD=51.3 seconds) and 114.55 seconds (SD=55.02 seconds), respectively. Repeated measures ANOVA indicated no significant difference in plasma vasopressin concentrations between the treatment groups over four minutes (P=.48).

Conclusions

The HIO route delivered vasopressin effectively in a swine model of VF. Occurrence, time, and odds of ROSC, as well as pharmacokinetic measurements of HIO vasopressin, were comparable to IV.

BurgertJM, JohnsonAD, Garcia-BlancoJ, FultonLV, LoughrenMJ. The Resuscitative and Pharmacokinetic Effects of Humeral Intraosseous Vasopressin in a Swine Model of Ventricular Fibrillation. Prehosp Disaster Med. 2017;32(3):305–310.

Keywords

cardiac arrestintraosseousresuscitationROSCvasopressin
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 32 , Issue 3 , June 2017 , pp. 305 - 310
Copyright
© World Association for Disaster and Emergency Medicine 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Conflicts of interest: All authors state there are no financial or personal relationships with people or organizations that would inappropriately influence this work. The views expressed in this work are those of the authors and do not reflect the official policy or views of the US Army, the US Department of Defense (Washington, DC USA), or the US Government.

References

1. 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.Google Scholar
2. Soar, J, Nolan, JP, Bottiger, BW, et al. European Resuscitation Council guidelines for resuscitation 2015: Section 3. Adult advanced life support. Resuscitation. 2015;95:100-147.CrossRefGoogle ScholarPubMed
3. Donnino, MW, Salciccioli, JD, Howell, MD, et al. Time to administration of epinephrine and outcome after in-hospital cardiac arrest with non-shockable rhythms: retrospective analysis of large in-hospital data registry. BMJ. 2014;348:g3028.Google Scholar
4. 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.Google Scholar
5. Johnson, D, Giles, K, Acuna, A, et al. Effects of tibial intraosseous and IV administration of vasopressin on kinetics and survivability in cardiac arrest. Am J Emerg Med. 2016;34(3):429-432.Google Scholar
6. Paquette, S, Gordon, C, Bradtmiller, B. Anthropometric Survey (ANSUR) II Pilot Study: Methods and Summary Statistics. Natick, Massachusetts USA: US Army Natick Soldier Research, Development and Engineering Center; 2009: 74-75.Google Scholar
7. National Research Council, Committee for the Update of the Guide for the Care and Use of Laboratory Animals, Institute for Laboratory Animal Research, et al. Guide for the Care and Use of Laboratory Animals. Washington, DC USA: National Academies Press; 2011.Google Scholar
8. Burgert, JM, Johnson, AD, Garcia-Blanco, JC, et al. An effective and reproducible model of ventricular fibrillation in crossbred Yorkshire swine (Sus scrofa) for use in physiologic research. Comp Med. 2015;65(5):444-447.Google ScholarPubMed
9. Mader, TJ, Kellogg, AR, Walterscheid, JK, et al. A randomized comparison of cardiocerebral and cardiopulmonary resuscitation using a swine model of prolonged ventricular fibrillation. Resuscitation. 2010;81(5):596-602.Google Scholar
10. 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.Google Scholar
11. Schwarz, B, Mair, P, Wagner-Berger, H, et al. Neither vasopressin nor amiodarone improve CPR outcome in an animal model of hypothermic cardiac arrest. Acta Anaesthesiol Scand. 2003;47(9):1114-1118.Google Scholar
12. 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):S6-10.Google Scholar
13. Weiser, G, Hoffmann, Y, Galbraith, R, et al. Current advances in intraosseous infusion - a systematic review. Resuscitation. 2012;83(1):20-26.Google Scholar
14. Buxton, ILO. “Pharmacokinetics and pharmacodynamics; the dynamics of drug absorption, distribution, action, and elimination.” In: Brunton LL, Lazo JS, Parker KL, (eds). Goodman and Gilman’s, The Pharmacological Basis of Therapeutics. 11 ed. New York, New York USA: McGraw-Hill Companies, Inc.; 2006:3-16.Google Scholar
15. Levitan, RM, Bortle, CD, Snyder, TA, et al. Use of a battery-operated needle driver for intraosseous access by novice users: skill acquisition with cadavers. Ann Emerg Med. 2009;54(5):692-694.Google Scholar
16. Santos, D, Carron, PN, Yersin, B, et al. EZ-IO intraosseous device implementation in a prehospital emergency service: a prospective study and review of the literature. Resuscitation. 2013;84(4):440-445.CrossRefGoogle Scholar
17. Paxton, JH, Knuth, TE, Klausner, HA. Proximal humerus intraosseous infusion: a preferred emergency venous access. J Trauma. 2009;67(3):606-611.Google Scholar
18. Malkiewicz, A, Dziedzic, M. Bone marrow reconversion - imaging of physiological changes in bone marrow. Pol J Radiol. 2012;77(4):45-50.Google ScholarPubMed
19. Swindle, MM, Makin, A, Herron, AJ, et al. Swine as models in biomedical research and toxicology testing. Vet Pathol. 2012;49(2):344-356.CrossRefGoogle ScholarPubMed
20. Walcott, GP, Kroll, MW, Ideker, RE. Ventricular fibrillation: are swine a sensitive species? J Interv Card Electrophysiol. 2015;42(2):83-89.Google Scholar
21. Niemann, JT, Rosborough, JP, Youngquist, S, et al. Is all ventricular fibrillation the same? A comparison of ischemically induced with electrically induced ventricular fibrillation in a porcine cardiac arrest and resuscitation model. Crit Care Med. 2007;35(5):1356-1361.Google Scholar
22. Kroll, MW, Fish, RM, Calkins, H, et al. Defibrillation success rates for electrically-induced fibrillation: hair of the dog. Conf Proc IEEE Eng Med Biol Soc. 2012;2012:689-693.Google Scholar