Intramuscular vs. Intravenous Epinephrine administration in a Pediatric Porcine Model of Cardiopulmonary Resuscitation
Intramuscular vs. Intravenous Epinephrine Administration in a Pediatric Porcine Model of Cardiopulmonary Resuscitation
Background
In pediatric resuscitation, epinephrine is a cornerstone drug for managing cardiac arrest. The American Heart Association Pediatric Life Support guidelines recommend epinephrine administration via intravenous (IV) or intraosseous (IO) routes, with endotracheal (ET) administration permitted if IV/IO access is unavailable. However, establishing these access points can take valuable minutes and may require specific skills or equipment that aren’t always readily accessible. Given the urgency of the situation, intramuscular (IM) epinephrine offers a potentially faster and more immediate alternative, but current data on its use in pediatric cardiac arrest is limited.
Aim
The study aimed to compare the effects of intramuscular (IM) and intravenous (IV) epinephrine in a pediatric porcine model of asphyxia-induced cardiac arrest. The researchers hypothesized that in this model, IM epinephrine would lead to a similar time to return of spontaneous circulation (ROSC) compared to IV epinephrine.
Methods
In this controlled study, 20 pediatric piglets aged 5–10 days were used to simulate pediatric cardiopulmonary resuscitation (CPR). The piglets were first anesthetized and then subjected to asphyxia-induced cardiac arrest by clamping their endotracheal tubes. Once they entered either bradycardic or asystolic cardiac arrest, the piglets were randomized to receive epinephrine either through the IM or IV route (n=5 per group for each type of arrest).
Key physiological markers such as time to ROSC, heart rate, arterial blood pressure, carotid blood flow, cardiac function, and cerebral oxygenation were continuously monitored. Additionally, blood samples were taken throughout the resuscitation process to measure plasma epinephrine concentration.
Results
The study found that the time to ROSC and the number of piglets achieving ROSC were comparable between the IM and IV groups in both bradycardic and asystolic cardiac arrest scenarios.
Conclusions
This study provides preliminary evidence that IM epinephrine can achieve similar outcomes to IV epinephrine in pediatric cardiac arrest situations. While IV/IO administration remains the gold standard, IM epinephrine may offer a viable first-line treatment option when these access points are delayed. However, more extensive, randomized trials in human populations are necessary to confirm these findings before they can be integrated into pediatric resuscitation protocols.
Implications for Pediatric Resuscitation
The potential for IM epinephrine to serve as an immediate intervention during pediatric CPR is exciting, especially in settings where IV/IO access may not be readily achievable. If future studies validate these findings, IM administration could be a practical solution in time-sensitive resuscitation scenarios, allowing healthcare providers to initiate treatment more quickly.
This research adds to the growing body of evidence exploring alternative routes of epinephrine administration, highlighting the importance of finding rapid and effective solutions in pediatric emergency care.
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