Sternal Route More Effective than Tibial Route for Intraosseous Amiodarone Administration in a Swine Model of Ventricular Fibrillation

Abstract

The SIO and IV routes of amiodarone administration were comparable. The TIO group took nearly three times longer to reach Tmax than the SIO and IV groups, likely indicating depot of lipid-soluble amiodarone in adipose-rich tibial yellow bone marrow. The SIO route was more effective than the TIO route for amiodarone delivery in a swine model of VF with ongoing CPR. Further investigations are necessary to determine if the kinetic differences found between the SIO and TIO routes in this study affect survival of VF in humans.

Sternal Intraosseous Devices: Review of the Literature

“… 34 Burger et al found that for amiodarone, a lipid soluble medication, C(max) was slowest for tibial IO and equivalent for both sternal IO and PIV. 35 The authors hypothesized that the lipid-rich marrow in the tibial site resulted in an amiodarone depot, delaying release to the peripheral circulation.…”

“… 27 Additionally, the insertion site has minimal overlaying tissue except for in extreme obesity, again making identification straightforward. 35 Sternal IO devices also have more direct access to central circulation via the venous drainage of the manubrium, as Burgert et al noted, and may actually benefit from “the hydraulic action of chest compressions” in cases of cardiac arrest. 33 , 35 Finally, FAST1 IO devices do not require selection of different needle sizes and rely on deployment of a single needle size to the correct depth.…”

“… 35 Sternal IO devices also have more direct access to central circulation via the venous drainage of the manubrium, as Burgert et al noted, and may actually benefit from “the hydraulic action of chest compressions” in cases of cardiac arrest. 33 , 35 Finally, FAST1 IO devices do not require selection of different needle sizes and rely on deployment of a single needle size to the correct depth. 32 This reduces the possibility for error and increases cognitive offloading of needle selection based on patient size during stressful patient care scenarios.…”

“…28 Multiple successful swine studies have been conducted with active CPR and concurrent sternal IO fluid administration without issue. 19,[33][34][35]44 Based on the findings of their swine study, Hoskins et al recommended that sternal IO be used preferentially for drug delivery over other IO sites when PIV has not been established. 33 Several recent human field studies have been conducted looking at the use of sternal IO.…”

Impaired Pharmacokinetics of Amiodarone under Veno-Venous Extracorporeal Membrane Oxygenation: From Bench to Bedside

“…An amiodarone 300 mg bolus diluted in 10 mL of 5% glucose solution was administered after cardiac arrest induction. According to previously published data about monitoring amiodarone PK during CPR in swine models [ 18 , 19 , 20 ], serial blood specimens (10 mL) were collected from the aortic arterial line, at 30, 60, 90, 120, 150, 180, 240, 300 s, and at 6, 8, 10, and 12 min after amiodarone injection. Prior to each specimen collection, 10 mL of blood were aspirated and discarded to avoid any dilution effect or contamination.…”