The effects of sternal intraosseous and intravenous administration of amiodarone in a hypovolemic swine cardiac arrest model


  • Samuel Smith, BSN
  • Bradley Borgkvist, BSN
  • Teara Kist, BSN
  • Jason Annelin, BSN
  • Don Johnson, PhD
  • Robert Long, PhD, CRNA



amiodarone, intraosseous, return of spontaneous circulation, pharmacokinetics, resuscitation, hemorrhage


Objective: This study compared the effects of amiodarone via sternal intraosseous (SIO) and intravenous (IV) routes on return of spontaneous circulation (ROSC), time to ROSC, concentration maximum (Cmax), time to maximum concentration (Tmax), and mean concentrations over time in a hypovolemic cardiac arrest model.

Design: Prospective, between subjects, randomized experimental design.

Setting: TriService Research Facility.

Subjects: Yorkshire-cross swine (n = 28).

Intervention: Swine were anesthetized and placed into cardiac arrest. After 2 minutes, cardiopulmonary resuscitation was initiated. After an additional 2 minutes, amiodarone 300 mg was administered via the tibial intraosseous TIO or the IV route. Blood samples were collected over 5 minutes. The plasma concentrations were analyzed using high-performance liquid chromatography tandem mass spectrometry.

Main Outcome Measurements: ROSC, time to ROSC, Cmax, Tmax, and mean concentrations over time.

Results: A multivariate analyses of variance indicated that there were no significant differences in the SIO and IV groups in ROSC (p = 0.191), time to ROSC (p > 0.05), Tmax mean 88.1 ± 24.8 seconds versus 49.5 ± 21.8 seconds (p = 0.317), or Cmax mean 92,700 ± 161,112 ng/mL versus 64,159.8 ± 14,174.8 ng/mL (p = 0.260). A repeated analyses of variance indicated that there were no significant differences between the groups relative to concentrations over time (p > 0.05).

Conclusion: The SIO provides rapid and reliable access to administer life-saving medications during cardiac arrest.

Author Biographies

Samuel Smith, BSN

CPT, Student, US Army Graduate Program in Anesthesia Nursing, Fort Sam Houston, San Antonio, Texas

Bradley Borgkvist, BSN

CPT, Student, US Army Graduate Program in Anesthesia Nursing, Fort Sam Houston, San Antonio, Texas

Teara Kist, BSN

1LT, Student, US Army Graduate Program in Anesthesia Nursing, Fort Sam Houston, San Antonio, Texas

Jason Annelin, BSN

1LT, Student, US Army Graduate Program in Anesthesia Nursing, Fort Sam Houston, San Antonio, Texas

Don Johnson, PhD

Faculty Member and Co-Director of Research, US Army Graduate Program in Anesthesia Nursing, Fort Sam Houston, San Antonio, Texas

Robert Long, PhD, CRNA

LTC, Faculty Member and Co-Director of Research, US Army Graduate Program in Anesthesia Nursing, Fort Sam Houston, San Antonio, Texas



Mozaffarian D, Benjamin EJ, Go AS, et al.: Heart disease and stroke statistics--2015 update: A report from the American Heart Association. Circulation. 2015; 131(4): e29-322.

Berdowski J, Berg RA, Tijssen JG, et al.: Global incidences of out-of-hospital cardiac arrest and survival rates: Systematic review of 67 prospective studies. Resuscitation. 2010; 81(11): 1479-1487.

Chan PS, McNally B, Tang F, et al.: Recent trends in survival from out-of-hospital cardiac arrest in the United States. Circulation. 2014; 130(21): 1876-1882.

Larsen MP, Eisenberg MS, Cummins RO, et al.: Predicting survival from out-of-hospital cardiac arrest: A graphic model. Ann Emerg Med. 1993; 22(11): 1652-1658.

Olasveengen TM, Sunde K, Brunborg C, et al.: Intravenous drug administration during out-of-hospital cardiac arrest: A randomized trial. JAMA. 2009; 302(20): 2222-2229.

Buck ML, Wiggins BS, Sesler JM: Intraosseous drug administration in children and adults during cardiopulmonary resuscitation. Ann Pharmacother. 2007; 41(10): 1679-1686.

Eastridge BJ, Mabry RL, Seguin P, et al.: Death on the battlefield (2001-2011): Implications for the future of combat casualty care. J Trauma Acute Care Surg. 2012; 73(6)(suppl 5): S431-S437.

Kauvar DS, Lefering R, Wade CE: Impact of hemorrhage on trauma outcome: An overview of epidemiology, clinical presentations, and therapeutic considerations. J Trauma. 2006; 60(6)(suppl): S3-S11.

Benson G: Intraosseous access to the circulatory system: An under-appreciated option for rapid access. J Perioper Pract. 2015; 25(7-8): 140-143.

Leidel BA, Kirchhoff C, Braunstein V, et al.: Comparison of two intraosseous access devices in adult patients under resuscitation in the emergency department: A prospective, randomized study. Resuscitation. 2010; 81(8): 994-999.

Reades R, Studnek JR, Garrett JS, et al.: Comparison of first-attempt success between tibial and humeral intraosseous insertions during out-of-hospital cardiac arrest. Prehosp Emerg Care. 2011; 15(2): 278-281.

Rosenberg H, Cheung WJ: Intraosseous access. CMAJ. 2013; 185(5): E238.

Blebea JS, Houseni M, Torigian DA, et al.: Structural and functional imaging of normal bone marrow and evaluation of its age-related changes. Semin Nucl Med. 2007; 37(3): 185-194.

Gross PM, Heistad DD, Marcus ML: Neurohumoral regulation of blood flow to bones and marrow. Am J Physiol. 1979; 237(4): H440-448.

Hoskins SL, do Nascimento P Jr, Lima RM, et al.: Pharmacokinetics of intraosseous and central venous drug delivery during cardiopulmonary resuscitation. Resuscitation. 2012; 83(1): 107-112.

Von Hoff DD, Kuhn JG, Burris HA 3rd, et al.: Does intraosseous equal intravenous? A pharmacokinetic study. Am J Emerg Med. 2008; 26 (1): 31-38.

Katzung B, Trevor A: Basic & Clinical Pharmacology. 13th ed. New York: McGraw Hill Education, 2015.

Mizzi A, Tran T, Mangar D, et al.: Amiodarone supplants lidocaine in ACLS and CPR protocols. Anesthesiol Clinics. 2011; 29(3): 535-545.

Dorian P, Cass D, Schwartz B, et al.: Amiodarone as compared with lidocaine for shock-resistant ventricular fibrillation. N Engl J Med. 2002; 346(12): 884-890.

Swindle MM, Makin A, Herron AJ, et al.: Swine as models in biomedical research and toxicology testing. Vet Pathol. 2012; 49(2): 344-356.

Burgert JM, Johnson AD, Garcia-Blanco JC, et al.: An effective and reproducible model of ventricular fibrillation in crossbred Yorkshire Swine (Sus scrofa) for use in physiologic research. Comp Med. 2015; 65(5): 444-447.

Yokota M, Bathalon GP, Berglund LG: Assessment of male anthropometric trends and the effects on simulated heat stress responses. Eur J Appl Physiol. 2008; 104(2): 297-302.

Marik PE. Noninvasive cardiac output monitors: A state-of the-art review. J Cardiothorac Vasc Anesth. 2013; 27(1): 121-134.

Crick SJ, Sheppard MN, Ho SY, et al.: Anatomy of the pig heart: Comparisons with normal human cardiac structure. J Anat. 1998; 193(Pt 1): 105-119.

Butler FK, Holcomb JB, Schreiber MA, et al.: Fluid resuscitation for hemorrhagic shock in tactical combat casualty care: TCCC guidelines change 14-01 - 2 June 2014. J Spec Oper Med. 2014; 14(3): 13-38.

Neumar RW, Otto CW, Link MS, et al.: Part 8: Adult advanced cardiovascular life support: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2010; 122(18)(suppl 3): S729-S767.

Hsieh Y, Korfmacher WA: Increasing speed and throughput when using HPLC-MS/MS systems for drug metabolism and pharmacokinetic screening. Curr Drug Metab. 2006; 7(5): 479-489.

Burgert J, Gegel B, Loughren M, et al.: Comparison of tibial intraosseous, sternal intraosseous, and intravenous routes of administration on pharmacokinetics of epinephrine during cardiac arrest: A pilot study. AANA J. 2012; 80(4)(suppl): S6-S10.

Warren DW, Kissoon N, Mattar A, et al.: Pharmacokinetics from multiple intraosseous and peripheral intravenous site injections in normovolemic and hypovolemic pigs. Critical Care Med. 1994; 22(5): 838-843.

Orlowski JP, Porembka DT, Gallagher JM, et al.: Comparison study of intraosseous, central intravenous, and peripheral intravenous infusions of emergency drugs. Am J Dis Child. 1990; 144(1): 112-117.

Hannon JP, Bossone CA, Wade CE: Normal physiological values for conscious pigs used in biomedical research. Lab Animal Sci. 1990; 40(3): 293-298.



How to Cite

Smith, BSN, S., B. Borgkvist, BSN, T. Kist, BSN, J. Annelin, BSN, D. Johnson, PhD, and R. Long, PhD, CRNA. “The Effects of Sternal Intraosseous and Intravenous Administration of Amiodarone in a Hypovolemic Swine Cardiac Arrest Model”. American Journal of Disaster Medicine, vol. 11, no. 4, Oct. 2016, pp. 271-7, doi:10.5055/ajdm.2016.0249.

Similar Articles

You may also start an advanced similarity search for this article.

Most read articles by the same author(s)

1 2 > >>