Pharmacokinetics of intraosseous and central venous drug delivery during cardiopulmonary resuscitation

Abstract We compared the pharmacokinetics of intraosseous (IO) drug delivery via tibia or sternum, with central venous (CV) drug delivery during cardiopulmonary resuscitation (CPR). Methods CPR of anesthetized KCl arrest swine was initiated 8min post arrest. Evans blue and indocyanine green, each were simultaneously injected as a bolus with adrenaline through IO sternal and tibial needles, respectively, n =7. In second group ( n =6) simultaneous IO sternal and IV central venous (CV) injections were made. Results Peak arterial blood concentrations were achieved faster for sternal IO vs. tibial IO administration (53±11s vs. 107±27s, p =0.03). Tibial IO dose delivered was 65% of sternal administration ( p =0.003). Time to peak blood concentration was similar for sternal IO and CV administration (97±17s vs. 70±12s, respectively; p =0.17) with total dose delivered of sternal being 86% of the dose delivered via CV ( p =0.22). Conclusions IO drug administrations via either the sternum or tibia were effective during CPR in anesthetized swine. However, IO drug administration via the sternum was significantly faster and delivered a larger dose.