• James M Burgert, Paul N Austin, and Arthur Johnson.
• U.S. Army Graduate Program in Anesthesia Nursing, Department of the Army Academy of the Health Sciences, 3490 Forage Road, Fort Sam Houston, TX 78234-6130.
• Mil Med. 2014 Jan 1;179(1):99-104.

ObjectivesIntraosseous (IO) access, enabling the rapid administration of epinephrine during cardiac arrest (CA), is crucial in promoting optimal postresuscitation outcomes in patients with poor vascular access. There is a question whether IO-administered epinephrine is equivalent to intravenously administered epinephrine during CA.MethodsThe question guiding this evidence-based review was as follows: in adults suffering CA given epinephrine via the IO route, what is the resulting serum concentration of the drug compared to when administered intravenously? A search was conducted and the evidence appraised and leveled.ResultsFour animal studies met the inclusion criteria. The sources showed no definitive evidence supporting equivalence between intravenous and IO epinephrine administered during CA. Intravenously administered epinephrine provides increased and faster appearing serum concentrations than IO-administered epinephrine. Evidence indicated epinephrine given via the sternal IO route more closely approaches equivalence with intravenously administered epinephrine than when administered by the tibial IO route.ConclusionsThe clinician should consider using proximal IO infusion sites such as the sternum or humerus when administering advanced cardiac life support drugs to rapidly achieve maximal therapeutic concentrations. Further studies are needed to determine the differences seen when epinephrine is administered by these routes during CA.Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

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