Pharmacokinetics of intraosseous and central venous drug delivery during cardiopulmonary resuscitation

Resuscitation. 2012 Jan;83(1):107-12. doi: 10.1016/j.resuscitation.2011.07.041. Epub 2011 Aug 25.


We compared the pharmacokinetics of intraosseous (IO) drug delivery via tibia or sternum, with central venous (CV) drug delivery during cardiopulmonary resuscitation (CPR).

Methods: CPR of anesthetized KCl arrest swine was initiated 8 min post arrest. Evans blue and indocyanine green, each were simultaneously injected as a bolus with adrenaline through IO sternal and tibial needles, respectively, n=7. In second group (n=6) simultaneous IO sternal and IV central venous (CV) injections were made.

Results: Peak arterial blood concentrations were achieved faster for sternal IO vs. tibial IO administration (53±11 s vs. 107±27 s, p=0.03). Tibial IO dose delivered was 65% of sternal administration (p=0.003). Time to peak blood concentration was similar for sternal IO and CV administration (97±17 s vs. 70±12 s, respectively; p=0.17) with total dose delivered of sternal being 86% of the dose delivered via CV (p=0.22).

Conclusions: IO drug administrations via either the sternum or tibia were effective during CPR in anesthetized swine. However, IO drug administration via the sternum was significantly faster and delivered a larger dose.

Publication types

  • Comparative Study

MeSH terms

  • Animals
  • Cardiopulmonary Resuscitation / methods*
  • Catheterization, Central Venous / methods*
  • Coloring Agents / administration & dosage
  • Coloring Agents / pharmacokinetics*
  • Disease Models, Animal
  • Dose-Response Relationship, Drug
  • Epinephrine / administration & dosage
  • Epinephrine / pharmacokinetics*
  • Evans Blue / administration & dosage
  • Evans Blue / pharmacokinetics
  • Indocyanine Green / administration & dosage
  • Indocyanine Green / pharmacokinetics
  • Infusions, Intraosseous / methods*
  • Infusions, Intravenous / methods*
  • Out-of-Hospital Cardiac Arrest / blood
  • Out-of-Hospital Cardiac Arrest / therapy*
  • Spectrophotometry
  • Sternum
  • Swine
  • Tibia


  • Coloring Agents
  • Evans Blue
  • Indocyanine Green
  • Epinephrine