If IV access is unsuccessful, which drugs can be given via the intraosseous route? 1
Dosing The maximum cumulative dose in a 24 hour period should not exceed 2
Intraosseous is the preferred route if intravenous access is not available
Objective: This study compared the effects of amiodarone via sternal
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Prehosp Emerg
Give adrenaline 1 mg IV (IO) after the 3 rd shock for adult patients in cardiac arrest with a shockable rhythm
Epinephrine 2
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In 1934, Josefson used for the first time an IO access in humans via sternal location to administer liver concentrate in patients with pernicious anemia
7 Success rates were also higher and achieved more quickly for IO when compared to CVC (85 versus 60 percent; 2 versus 8 minutes)
Though classified as a class III antiarrhythmic 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 Although in adults peak drug concentrations are lower and circulation times longer when drugs are administered via peripheral sites rather than central sites, Intraosseous (IO) cannulation provides access to a noncollapsible venous plexus, enabling drug delivery similar to that achieved by central venous access
Of the five randomized trials, only one study included a subgroup analysis comparing IO and IV (Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Cardiac Arrest An evidence-based review of epinephrine administered via the intraosseous route in animal models of cardiac arrest
or• Lidocaine IV/IO dose: First dose: 1-1
Return of Spontaneous Circulation (ROSC) • Pulse and blood pressure • Abrupt sustained increase in Petco 2 (typically ≥40 mm Hg) 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 An evidence-based review of epinephrine administered via the intraosseous route in animal models of cardiac arrest
2020; 141: 188-198
Objective This study compared the effects of amiodarone via tibial intraosseous (TIO) and intravenous (IV) routes on return of spontaneous circulation (ROSC), time to ROSC, maximum drug concentration (Cmax), time to maximum concentration (Tmax), and mean concentrations
019 (95% confidence interval 1
Of those OHCA patients, 29,688 had received an IV access, 1,303 an IO access, 4,827 both IO and IV accesses and 276 patients had received both ET and IV therapy (Table 2)
Objective: This study compared the effects of amiodarone via tibial intraosseous (TIO) and intravenous (IV) routes on return of spontaneous circulation (ROSC), time to ROSC, maximum drug Here is the caveat
ILCOR says, “If intravenous access is difficult or impossible, consider the IO route
Evidence in cardiac arrest, however, is poor
9% sodium chloride
After giving hand off the medic tells you she had difficulty finding intravenous (IV) access and went straight to an IO
Lidocaine 3