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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: [email protected]
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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 

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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.

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