Intraosseous vasopressin improves coronary perfusion pressure rapidly during cardiopulmonary resuscitation in pigs

Objective: Intravenous administration of vasopressin during cardiopulmonary resuscitation (CPR) may be more effective than optimal doses of epinephrin e, The main purpose of this study was to determine whether intraosseous vas opressin achieves serum drug levels comparable with intravenous doses durin g CPR and, additionally, to evaluate the effects of intraosseous vasopressi n during CPR. Design: Prospective, randomized laboratory investigation using an establish ed porcine model with instrumentation for measurement of hemodynamic variab les, blood gases, and return of spontaneous circulation. Setting: University hospital laboratory. Subjects: Twelve domestic pigs. Interventions: After 4 mins of untreated ventricular fibrillation and 3 min s of CPR, 12 pigs were randomized to be treated with intravenous administra tion of vasopressin (0.8 unit/kg vasopressin; n = 6) or intraosseous vasopr essin (0.8 unit/kg vasopressin; n = 6). Defibrillation was performed 5 mins after drug administration to attempt the return of spontaneous circulation . Measurements and Main Results: At both 90 sees and 5 mins after drug admini stration, intravenous and intraosseous administration of vasopressin result ed in comparable mean (+/- SEM) coronary perfusion pressure (43 +/- 4 vs. 4 4 +/- 3 and 30 +/- 2 vs. 37 +/- 2 mm Hg, respectively) and vasopressin plas ma concentrations (13,706 +/- 1,857 vs, 16,166 +/- 3,114 pg/mL and 10,372 /- 883 vs. 8246 +/- 2211 pg/mL, respectively). All animals in both groups w ere successfully resuscitated; pigs that received intraosseous vasopressin had a significantly higher (p < .05) mean arterial (92 +/- 6 vs. 129 +/- 12 mm Hg) and coronary perfusion pressure (84 +/- 11 vs. 119 +/- 11 mm Hg) at 5 mins of return of spontaneous circulation. Conclusions: Intraosseous vasopressin resulted in comparable vasopressin pl asma levels, hemodynamic variables, and return of spontaneous circulation r ates as did intravenous vasopressin. Intraosseous vasopressin may be an alt ernative for vasopressor administration during CPR, when intravenous access is delayed or not available.