From the United States Army Graduate Program of Anesthesia Nursing, San Antonio, TX.
Department of Emergency Medicine, New York-Presbyterian/Queens, Flushing, NY.
Pediatr Emerg Care. 2022 Apr 1;38(4):e1166-e1172. doi: 10.1097/PEC.0000000000002127.
We compared the efficacy of tibial intraosseous (TIO) administration of epinephrine in a pediatric normovolemic versus hypovolemic cardiac arrest model to determine the incidence of return of spontaneous circulation (ROSC) and plasma epinephrine concentrations over time.
This experimental study evaluated the pharmacokinetics of epinephrine and/or incidence of ROSC after TIO administration in either a normovolemic or hypovolemic pediatric swine model.
All subjects in the TIO normovolemia cardiac arrest group experienced ROSC after TIO administration of epinephrine. In contrast, subjects experiencing hypovolemia and cardiac arrest were significantly less likely to experience ROSC when epinephrine was administered TIO versus intravenous (TIO hypovolemia: 14% [1/7] vs IV hypovolemia: 71% [5/7]; P = 0.031). The TIO hypovolemia group exhibited significantly lower plasma epinephrine concentrations versus IV hypovolemia at 60, 90, 120, and 150 seconds (P < 0.05). Although the maximum concentration of plasma epinephrine was similar, the TIO hypovolemia group exhibited significantly slower time to maximum concentration times versus TIO normovolemia subjects (P = 0.004).
Tibial intraosseous administration of epinephrine reliably facilitated ROSC among normovolemic cardiac arrest pediatric patients, which is consistent with published reports. However, TIO administration of epinephrine was ineffective in restoring ROSC among subjects experiencing hypovolemia and cardiac arrest. Tibial intraosseous-administered epinephrine during hypovolemia and cardiac arrest may have resulted in a potential sequestration of epinephrine in the tibia. Central or peripheral intravascular access attempts should not be abandoned after successful TIO placement in the resuscitation of patients experiencing concurrent hypovolemia and cardiac arrest.
我们比较了在儿童等容性与低血容量性心脏骤停模型中经胫骨骨髓腔内（TIO）给予肾上腺素的疗效，以确定随着时间的推移，自主循环恢复（ROSC）的发生率和血浆肾上腺素浓度。
本实验研究评估了在等容性或低血容量性小儿猪模型中，TIO 给予肾上腺素后的肾上腺素药代动力学和/或 ROSC 发生率。
TIO 等容性心脏骤停组中的所有受试者在 TIO 给予肾上腺素后均经历了 ROSC。相比之下，当 TIO 给予肾上腺素时，经历低血容量和心脏骤停的受试者发生 ROSC 的可能性显著降低，TIO 低血容量组：14%（1/7），而 IV 低血容量组：71%（5/7）；P=0.031）。TIO 低血容量组在 60、90、120 和 150 秒时的血浆肾上腺素浓度明显低于 IV 低血容量组（P<0.05）。尽管最大血浆肾上腺素浓度相似，但 TIO 低血容量组达到最大浓度的时间明显慢于 TIO 等容性组（P=0.004）。
胫骨骨髓腔内给予肾上腺素可靠地促进了等容性心脏骤停儿科患者的 ROSC，这与已发表的报告一致。然而，在经历低血容量和心脏骤停的患者中，TIO 给予肾上腺素无法恢复 ROSC。在低血容量和心脏骤停期间，胫骨内给予肾上腺素可能导致肾上腺素在胫骨内的潜在隔离。在复苏同时经历低血容量和心脏骤停的患者中，成功放置 TIO 后不应放弃中央或外周血管内通路的尝试。
