Epinephrine improves 24-hour survival in a swine model of prolonged ventricular fibrillation demonstrating that early intraosseous is superior to delayed intravenous administration

Mathias Zuercher, Karl B Kern, Julia H Indik, Michael Loedl, Ronald W. Hilwig, Wolfgang Ummenhofer, Robert A. Berg, Gordon A. Ewy

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Background: Vasopressors administered IV late during resuscitation efforts fail to improve survival. Intraosseous (IO) access can provide a route for earlier administration. We hypothesized that IO epinephrine after 1 minute of cardiopulmonary resuscitation (CPR) (an "optimal" IO scenario) after 10 minutes of untreated ventricular fibrillation (VF) cardiac arrest would improve outcome in comparison with either IV epinephrine after 8 minutes of CPR (a "realistic" IV scenario) or placebo controls with no epinephrine. Methods: Thirty swine were randomized to IO epinephrine, IV epinephrine, or placebo. Important outcomes included return of spontaneous circulation (ROSC), 24-hour survival, and 24-hour survival with good neurological outcome (cerebral performance category 1). Results: ROSC after 10 minutes of untreated VF was uncommon without administration of epinephrine (1 of 10), whereas ROSC was nearly universal with IO epinephrine or delayed IV epinephrine (10 of 10 and 9 of 10, respectively; P = 0.001 for either versus placebo). Twenty-four hour survival was substantially more likely after IO epinephrine than after delayed IV epinephrine (10 of 10 vs. 4 of 10, P = 0.001). None of the placebo group survived at 24 hours. Survival with good neurological outcome was more likely after IO epinephrine than after placebo (6 of 10 vs. 0 of 10, P = 0.011), and only 3 of 10 survived with good neurological outcome in the delayed IV epinephrine group (not significant versus either IO or placebo). Conclusion: In this swine model of prolonged VF cardiac arrest, epinephrine administration during CPR improved outcomes. In addition, early IO epinephrine improved outcomes in comparison with delayed IV epinephrine.

Original languageEnglish (US)
Pages (from-to)884-890
Number of pages7
JournalAnesthesia and Analgesia
Volume112
Issue number4
DOIs
StatePublished - Apr 2011

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Ventricular Fibrillation
Intravenous Administration
Epinephrine
Swine
Placebos
Cardiopulmonary Resuscitation
Heart Arrest
Resuscitation

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Epinephrine improves 24-hour survival in a swine model of prolonged ventricular fibrillation demonstrating that early intraosseous is superior to delayed intravenous administration. / Zuercher, Mathias; Kern, Karl B; Indik, Julia H; Loedl, Michael; Hilwig, Ronald W.; Ummenhofer, Wolfgang; Berg, Robert A.; Ewy, Gordon A.

In: Anesthesia and Analgesia, Vol. 112, No. 4, 04.2011, p. 884-890.

Research output: Contribution to journalArticle

Zuercher, Mathias ; Kern, Karl B ; Indik, Julia H ; Loedl, Michael ; Hilwig, Ronald W. ; Ummenhofer, Wolfgang ; Berg, Robert A. ; Ewy, Gordon A. / Epinephrine improves 24-hour survival in a swine model of prolonged ventricular fibrillation demonstrating that early intraosseous is superior to delayed intravenous administration. In: Anesthesia and Analgesia. 2011 ; Vol. 112, No. 4. pp. 884-890.
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AU - Kern, Karl B

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AU - Loedl, Michael

AU - Hilwig, Ronald W.

AU - Ummenhofer, Wolfgang

AU - Berg, Robert A.

AU - Ewy, Gordon A.

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AB - Background: Vasopressors administered IV late during resuscitation efforts fail to improve survival. Intraosseous (IO) access can provide a route for earlier administration. We hypothesized that IO epinephrine after 1 minute of cardiopulmonary resuscitation (CPR) (an "optimal" IO scenario) after 10 minutes of untreated ventricular fibrillation (VF) cardiac arrest would improve outcome in comparison with either IV epinephrine after 8 minutes of CPR (a "realistic" IV scenario) or placebo controls with no epinephrine. Methods: Thirty swine were randomized to IO epinephrine, IV epinephrine, or placebo. Important outcomes included return of spontaneous circulation (ROSC), 24-hour survival, and 24-hour survival with good neurological outcome (cerebral performance category 1). Results: ROSC after 10 minutes of untreated VF was uncommon without administration of epinephrine (1 of 10), whereas ROSC was nearly universal with IO epinephrine or delayed IV epinephrine (10 of 10 and 9 of 10, respectively; P = 0.001 for either versus placebo). Twenty-four hour survival was substantially more likely after IO epinephrine than after delayed IV epinephrine (10 of 10 vs. 4 of 10, P = 0.001). None of the placebo group survived at 24 hours. Survival with good neurological outcome was more likely after IO epinephrine than after placebo (6 of 10 vs. 0 of 10, P = 0.011), and only 3 of 10 survived with good neurological outcome in the delayed IV epinephrine group (not significant versus either IO or placebo). Conclusion: In this swine model of prolonged VF cardiac arrest, epinephrine administration during CPR improved outcomes. In addition, early IO epinephrine improved outcomes in comparison with delayed IV epinephrine.

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