Comparison study of intraosseous, central intravenous, and peripheral intravenous infusions of emergency drugs
J. P. Orlowski, D. T. Porembka, J. M. Gallagher, J. D. Lockrem and F. VanLente
Pediatric and Surgical Intensive Care Unit, Cleveland Clinic Foundation, Ohio 44195-5086.
Intraosseous infusion of emergency drugs is a lifesaving alternative to
intravenous administration when intravenous access cannot be rapidly
established. We studied the comparative pharmacokinetics of the following
six emergency drugs and solutions: epinephrine hydrochloride, 0.01 mg/kg;
sodium bicarbonate, 1 mEq/kg; calcium chloride, 10 mg/kg; hydroxyethyl
starch, 10 mL/kg; 50% dextrose in water, 250 mg/kg; and lidocaine
hydrochloride, 1 mg/kg. Studies were conducted in normotensive,
anesthetized dogs, with three animals studied with each of the drugs or
solutions and each animal being treated with all three routes of
administration (central intravenous, peripheral intravenous, and
intraosseous) in randomized sequence. The effects of epinephrine were also
assessed in a shock model. The intraosseous route of administration was
comparable with the central and peripheral intravenous routes for all of
the emergency drugs and solutions studied, with equivalent magnitudes of
peak effect or drug level and equal or longer durations of action. Time to
placement of the intraosseous needle varied from 15 seconds to 5 minutes,
with a mean of 60 seconds. Time to placement of the needle varies with the
skill and experience of the individual. With experience, all individuals
could place the intraosseous needle in 60 seconds or less. The intraosseous
route is comparable in effect to the central and peripheral intravenous
routes of drug administration for epinephrine, sodium bicarbonate,
hydroxyethyl starch, calcium chloride, 50% dextrose in water, and lidocaine
and is a clinically feasible alternative when intravenous access will be
critically delayed.
