Pharmacokinetics of intraosseous and central venous drug delivery during cardiopulmonary resuscitation

Hoskins, Stephen L.; Nascimento, Paulo do; Lima, Rodrigo Moreira e; Espana-Tenorio, Jonathan M.; Kramer, George C.

doi:10.1016/j.resuscitation.2011.07.041

Cited by 96 publications

(54 citation statements)

References 37 publications

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“…This case and others (2) illustrate the need for an improved understanding of IO-LE to combat drug overdoses. In contrast to IV delivery, IO infusions may lead to lower peak drug concentration in the plasma and reduced efficacy (8). Our data indicate that IO-LE reverses LAST with a similar profile of cardiovascular variables to that of the conventional IV administration of LE without additional volume.…”

Section: Discussionmentioning

confidence: 72%

Intraosseous Lipid Emulsion

Fettiplace

Ripper

Lis

et al. 2014

Critical Care Medicine

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Section: Discussionmentioning

confidence: 72%

Intraosseous Lipid Emulsion

Fettiplace

Ripper

Lis

et al. 2014

Critical Care Medicine

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“…The benefit of this location is quicker time to insertion, 20 although time to peak medication concentration is slower than via the sternal route. 21 Flow rates via the tibia are also slower than via the humerus. 22 Tibial placement is also a subdiaphragmatic point of vascular access, which is not the preferred location 23 as blood return to the heart from this infusion point can be thwarted by other potential injuries (e.g., lowerextremity injuries, pelvic fractures, major intra-abdominal injuries).…”

Section: Discussionmentioning

confidence: 99%

Use of intraosseous devices in trauma: a survey of trauma practitioners in Canada, Australia and New Zealand

Engels

Erdoğan

Widder

et al. 2016

cjs

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Background: Although used primarily in the pediatric population for decades, the use of intraosseous (IO) devices in the resuscitation of severely injured adult trauma patients has recently become more commonplace. The objective of this study was to determine the experience level, beliefs and attitudes of trauma practitioners in Canada, Australia and New Zealand regarding the use of IO devices in adult trauma patients. Methods:We administered a web-based survey to all members of 4 national trauma and emergency medicine organizations in Canada, Australia and New Zealand. Survey responses were analyzed using descriptive statistics, univariate comparisons and a proportional odds model. Results:Overall, 425 of 1771 members completed the survey, with 375 being trauma practitioners. IO devices were available to 97% (353 of 363), with EZ-IO being the most common. Nearly all physicians (98%, 357 of 366) had previous training with IO devices, and 85% (223 of 261) had previously used an IO device in adult trauma patients. Most respondents (79%, 285 of 361) were very comfortable placing an IO catheter in the proximal tibia. Most physicians would always or often use an IO catheter in a patient without intravenous access undergoing CPR for traumatic cardiac arrest (84%, 274 of 326) or in a hypotensive patient (without peripheral intravenous access) after 2 attempts or 90 s of trying to establish vascular access (81%, 264 of 326). Conclusion:Intraosseous devices are readily available to trauma practitioners in Canada, Australia and New Zealand, and most physicians are trained in device placement. Most physicians surveyed felt comfortable using an IO device in resuscitation of adult trauma patients and would do so for indications broader than current guidelines. Contexte :Bien que le dispositif de perfusion intraosseuse soit depuis des décennies utilisé principalement chez les enfants, son utilisation lors de la réanimation d'adultes victimes de trauma grièvement blessés a récemment gagné en popularité. Notre étude vise à déterminer le niveau d'expérience, les croyances et les attitudes des spécialistes en traumatologie canadiens, australiens et néo-zélandais en ce qui concerne l'utilisation de ces dispositifs chez des patients adultes victimes de trauma. Méthodes

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“…In order to maximize the effectiveness of intraosseous access, clinicians must be trained in proper intraosseous use. Medications administered by the intraosseous route have a quick uptake via the osseous venous plexus, and the time to peak serum concentration is equivalent to intravenous or central venous access [6][7][8][9]. Therefore, intraosseous drug dosing is identical to intravenous dosing.…”

Section: Discussionmentioning

confidence: 99%