Background: The purpose of this study was to compare weight-based dose of epinephrine in Sternal Intraosseous (SIO) (0.05 mg/kg), SIO 1mg, and Intravenous (IV) 1 mg Groups in a hypovolemic, cardiac arrest model. Concentration maximum (Cmax), time to maximum concentration (Tmax), Mean Concentration over time (MC), Area Under the Curve (AUC), and frequency of Return of Spontaneous Circulation (ROSC) were compared.

Methods: 32 adult male castrated swine, sus scrofa (65-75kg), were placed into 4 groups: SIO 0.05 mg/kg, IV 1 mg, SIO 1 mg, Cardiopulmonary Resuscitation + Defibrillation (CPR+Defib), and CPR Only. The pigs were anesthetized, placed in cardiac arrest for 2 minutes, and CPR was then started and continued for 2 minutes. Epinephrine was then administered, and samples were collected over 5 minutes. The CPR+Defib Group had just defibrillation and the CPR-Only Group did not receive epinephrine nor defibrillation. Both served as control groups.

Results: The Cmax was significantly higher in the SIO 0.05mg/kg Group compared to the SIO 1 mg and the IV Groups (p = 0.001). There were no significant differences in Tmax in any of the groups (p > 0.05). The AUC was significantly higher in the SIO 0.05 mg/kg than in the SIO 1 mg and the IV Groups (p = 0.001). The MC of the SIO 0.05 mg/kg was higher than the SIO 1 mg and IV Groups at each time interval. The frequency of ROSC rate was 7 out of 8 in the SIO 0.05 mg Group, 3 out of 8 in both the IV and SIO 1 mg Groups, 2 out of 8 in the CPR+Defib Group, and 0 out of 8 in the CPR-Only Group.

Conclusion: The SIO 0.05 mg/kg Group should be used for adult patients in hypovolemic shock who have cardiac arrests.