{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T23:33:08Z","timestamp":1785367988523,"version":"3.55.0"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Pediatr Emer Care"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:sec>\n            <jats:title>Objective<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>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]; <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.031). The TIO hypovolemia group exhibited significantly lower plasma epinephrine concentrations versus IV hypovolemia at 60, 90, 120, and 150 seconds (<jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 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 (<jats:italic toggle=\"yes\">P<\/jats:italic> = 0.004).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>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\u2013administered 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.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/pec.0000000000002127","type":"journal-article","created":{"date-parts":[[2020,5,26]],"date-time":"2020-05-26T04:05:13Z","timestamp":1590465913000},"page":"e1166-e1172","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":6,"title":["Tibial Intraosseous Administration of Epinephrine Is Effective in Restoring Return of Spontaneous Circulation in a Pediatric Normovolemic But Not Hypovolemic Cardiac Arrest Model"],"prefix":"10.1097","volume":"38","author":[{"given":"Young J.","family":"Yauger","sequence":"first","affiliation":[{"name":"United States Army Graduate Program of Anesthesia Nursing, San Antonio, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle D.","family":"Johnson","sequence":"additional","affiliation":[{"name":"United States Army Graduate Program of Anesthesia Nursing, San Antonio, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordan","family":"Mark","sequence":"additional","affiliation":[{"name":"United States Army Graduate Program of Anesthesia Nursing, San Antonio, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tho","family":"Le","sequence":"additional","affiliation":[{"name":"United States Army Graduate Program of Anesthesia Nursing, San Antonio, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Woodruff","sequence":"additional","affiliation":[{"name":"United States Army Graduate Program of Anesthesia Nursing, San Antonio, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Silvey","sequence":"additional","affiliation":[{"name":"United States Army Graduate Program of Anesthesia Nursing, San Antonio, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Revis","sequence":"additional","affiliation":[{"name":"United States Army Graduate Program of Anesthesia Nursing, San Antonio, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dawn","family":"Blouin","sequence":"additional","affiliation":[{"name":"United States Army Graduate Program of Anesthesia Nursing, San Antonio, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"O'Sullivan","sequence":"additional","affiliation":[{"name":"United States Army Graduate Program of Anesthesia Nursing, San Antonio, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerianne","family":"Brady","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, New York-Presbyterian\/Queens, Flushing, NY."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie G.","family":"Hensler","sequence":"additional","affiliation":[{"name":"United States Army Graduate Program of Anesthesia Nursing, San Antonio, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Don","family":"Johnson","sequence":"additional","affiliation":[{"name":"United States Army Graduate Program of Anesthesia Nursing, San Antonio, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,5,22]]},"reference":[{"key":"bib1-20250504","first-page":"e56","article-title":"Heart disease and stroke statistics\u20142019 update: a report from the American Heart Association","volume":"139","year":"2019","journal-title":"Circulation"},{"key":"bib2-20250504","first-page":"e67","article-title":"Heart disease and stroke statistics\u20142018 update: a report from the American Heart Association","volume":"137","year":"2018","journal-title":"Circulationj"},{"key":"bib3-20250504","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1016\/j.annemergmed.2006.03.015","article-title":"Traumatic cardiac arrest: who are the survivors?","volume":"48","year":"2006","journal-title":"Ann Emerg Med"},{"key":"bib4-20250504","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1097\/NAN.0b013e3181e3a0a8","article-title":"Pediatric peripheral intravenous access: does nursing experience and competence really make a difference?","volume":"33","year":"2010","journal-title":"J Infus Nurs"},{"key":"bib5-20250504","doi-asserted-by":"crossref","first-page":"2032","DOI":"10.1161\/CIRCULATIONAHA.117.033067","article-title":"Time to epinephrine administration and survival from nonshockable out-of-hospital cardiac arrest among children and adults","volume":"137","year":"2018","journal-title":"Circulation"},{"key":"bib6-20250504","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.resuscitation.2011.07.041","article-title":"Pharmacokinetics of intraosseous and central venous drug delivery during cardiopulmonary resuscitation","volume":"83","year":"2012","journal-title":"Resuscitation"},{"key":"bib7-20250504","first-page":"293","article-title":"Normal physiological values for conscious pigs used in biomedical research","volume":"40","year":"1990","journal-title":"Lab Anim Sci"},{"key":"bib8-20250504","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1016\/S0022-3476(05)82901-4","article-title":"Plasma epinephrine concentrations after intraosseous and central venous injection during cardiopulmonary resuscitation in the lamb","volume":"116","year":"1990","journal-title":"J Pediatr"},{"key":"bib9-20250504","first-page":"112","article-title":"Comparison study of intraosseous, central intravenous, and peripheral intravenous infusions of emergency drugs","volume":"144","year":"1990","journal-title":"Am J Dis Child"},{"key":"bib10-20250504","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1177\/0300985811402846","article-title":"Swine as models in biomedical research and toxicology testing","volume":"49","year":"2012","journal-title":"Vet Pathol"},{"key":"bib11-20250504","first-page":"1","article-title":"CDC growth charts: United States","year":"2000","journal-title":"Adv Data"},{"key":"bib13-20250504","first-page":"444","article-title":"An effective and reproducible model of ventricular fibrillation in crossbred Yorkshire swine (Sus scrofa) for use in physiologic research","volume":"65","year":"2015","journal-title":"Comp Med"},{"issue":"suppl 2","key":"bib14-20250504","first-page":"S176","article-title":"Part 12: Pediatric Advanced Life Support: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care (reprint)","volume":"136","year":"2015","journal-title":"Pediatrics"},{"key":"bib15-20250504","first-page":"S526","article-title":"Part 12: Pediatric Advanced Life Support: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care","volume":"132","year":"2015","journal-title":"Circulation"},{"key":"bib16-20250504","doi-asserted-by":"crossref","first-page":"211","DOI":"10.5055\/ajdm.2016.0241","article-title":"Effects of tibial and humerus intraosseous and intravenous vasopressin in porcine cardiac arrest model","volume":"11","year":"2016","journal-title":"Am J Disaster Med"},{"key":"bib17-20250504","doi-asserted-by":"crossref","first-page":"222","DOI":"10.5811\/westjem.2015.12.28825","article-title":"Effects of intraosseous tibial vs. intravenous vasopressin in a hypovolemic cardiac arrest model","volume":"17","year":"2016","journal-title":"West J Emerg Med"},{"key":"bib18-20250504","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1016\/j.amsu.2015.08.005","article-title":"Effects of humeral intraosseous versus intravenous epinephrine on pharmacokinetics and return of spontaneous circulation in a porcine cardiac arrest model: a randomized control trial","volume":"4","year":"2015","journal-title":"Ann Med Surg (Lond)"},{"key":"bib19-20250504","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1016\/j.ajem.2015.11.027","article-title":"Effects of tibial intraosseous and IV administration of vasopressin on kinetics and survivability in cardiac arrest","volume":"34","year":"2016","journal-title":"Am J Emerg Med"},{"key":"bib20-20250504","doi-asserted-by":"crossref","first-page":"35","DOI":"10.55460\/4LYK-HTXM","article-title":"Comparison of muscle paralysis after intravenous and intraosseous administration of succinylcholine in swine","volume":"14","year":"2014","journal-title":"J Spec Oper Med"},{"key":"bib21-20250504","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1016\/j.jss.2015.11.015","article-title":"Effects of intraosseous epinephrine in a cardiac arrest swine model","volume":"201","year":"2016","journal-title":"J Surg Res"},{"key":"bib22-20250504","doi-asserted-by":"crossref","first-page":"1771","DOI":"10.4155\/fmc.12.113","article-title":"The development of swine models in drug discovery and development","volume":"4","year":"2012","journal-title":"Future Med Chem"},{"key":"bib23-20250504","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/j.amj.2019.02.005","article-title":"Effect of intravenous versus intraosseous access in prehospital cardiac arrest","volume":"38","year":"2019","journal-title":"Air Med J"},{"key":"bib24-20250504","doi-asserted-by":"crossref","first-page":"1911","DOI":"10.1148\/rg.2016160056","article-title":"MR imaging of pediatric bone marrow","volume":"36","year":"2016","journal-title":"Radiographics"},{"key":"bib25-20250504","first-page":"H440","article-title":"Neurohumoral regulation of blood flow to bones and marrow","volume":"237","year":"1979","journal-title":"Am J Physiol"},{"key":"bib26-20250504","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.resuscitation.2017.06.014","article-title":"Intraosseous compared to intravenous drug resuscitation in out-of-hospital cardiac arrest","volume":"117","year":"2017","journal-title":"Resuscitation"}],"container-title":["Pediatric Emergency Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/PEC.0000000000002127","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,4]],"date-time":"2025-05-04T18:06:09Z","timestamp":1746381969000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/PEC.0000000000002127"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5,22]]},"references-count":25,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2022]]}},"URL":"https:\/\/doi.org\/10.1097\/pec.0000000000002127","relation":{},"ISSN":["1535-1815","0749-5161"],"issn-type":[{"value":"1535-1815","type":"electronic"},{"value":"0749-5161","type":"print"}],"subject":[],"published":{"date-parts":[[2020,5,22]]}}}