O'Reilly Megan, Tijssen Janice A, Lee Tze-Fun, Ramsie Marwa, Cheung Po-Yin, Schmölzer Georg M
Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada.
Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Resusc Plus. 2024 Sep 13;20:100769. doi: 10.1016/j.resplu.2024.100769. eCollection 2024 Dec.
American Heart Association Pediatric Life Support guidelines recommend epinephrine administration via intravenous (IV) or intraosseous (IO) route, with endotracheal (ET) administration admissible in the absence of IV/IO access. Establishing IV/IO/ET access can take several minutes and may require proficient skills and/or specific equipment, which may not be readily available in all situations. Alternatively, intramuscular (IM) epinephrine could be administered immediately. At present, there is limited data on the use of IM epinephrine in pediatric resuscitation.
To compare IM with IV epinephrine in a pediatric porcine model of asphyxia-induced cardiac arrest. We hypothesized that in a pediatric animal model of cardiac arrest, IM epinephrine would result in a similar time to achieve return of spontaneous circulation (ROSC) to IV epinephrine.
Twenty pediatric piglets (5-10 days old) were anesthetized and asphyxiated by clamping the endotracheal tube. Piglets were randomized to IM or IV epinephrine with bradycardic or asystolic cardiac arrest ( = 5/group) and were resuscitated. Time to ROSC was recorded; blood plasma was collected throughout resuscitation for measurement of epinephrine concentration; heart rate, arterial blood pressure, carotid blood flow, cardiac function, and cerebral oxygenation were continuously recorded throughout the experiment.
Time to ROSC and the number of piglets that achieved ROSC were comparable between IM and IV epinephrine groups with either bradycardic or asystolic cardiac arrest.
In a pediatric piglet model of bradycardic and asystolic cardiac arrest, administration of IM epinephrine resulted in similar resuscitative outcomes to IV epinephrine. Although immediate IM epinephrine injection may provide a first-line treatment option until subsequent IV/IO access is established, large, randomized trials are needed to confirm our finding before it can be used during pediatric resuscitation.
美国心脏协会儿科生命支持指南推荐通过静脉（IV）或骨内（IO）途径给予肾上腺素，在无法建立IV/IO通路时可采用气管内（ET）给药。建立IV/IO/ET通路可能需要几分钟，且可能需要熟练的技能和/或特定设备，而这些在所有情况下并非都能随时获得。另外，可立即给予肌肉注射（IM）肾上腺素。目前，关于IM肾上腺素在儿科复苏中的应用数据有限。
在窒息诱导的心脏骤停儿科猪模型中比较IM与IV肾上腺素。我们假设在儿科心脏骤停动物模型中，IM肾上腺素实现自主循环恢复（ROSC）的时间与IV肾上腺素相似。
20只5至10日龄的仔猪麻醉后通过夹闭气管导管造成窒息。仔猪被随机分为接受IM或IV肾上腺素治疗，伴有心动过缓或心搏停止性心脏骤停（每组n = 5），并进行复苏。记录达到ROSC的时间；在整个复苏过程中收集血浆以测量肾上腺素浓度；在整个实验过程中持续记录心率、动脉血压、颈动脉血流、心脏功能和脑氧合情况。
在心动过缓或心搏停止性心脏骤停的情况下，IM和IV肾上腺素组之间达到ROSC的时间以及实现ROSC的仔猪数量相当。
在心动过缓和心搏停止性心脏骤停的儿科仔猪模型中，IM肾上腺素给药产生的复苏结果与IV肾上腺素相似。尽管在建立后续IV/IO通路之前立即注射IM肾上腺素可能提供一线治疗选择，但在可用于儿科复苏之前，需要进行大型随机试验来证实我们的发现。
