Journal article
A comparison of intraosseous and intravenous adrenaline administration during resuscitation of asphyxiated newborn lambs
- Abstract:
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Objective: Intraosseous access is recommended as a reasonable alternative for vascular access during newborn resuscitation if umbilical access is unavailable, but there are minimal reported data in newborns. We compared intraosseous with intravenous adrenaline administration, during resuscitation of severely asphyxiated lambs at birth.
Methods: Near-term lambs (139 days’ gestation) were instrumented antenatally for measurement of carotid and pulmonary blood flow, and systemic blood pressure. Intrapartum asphyxia was induced by umbilical cord clamping, until asystole. Resuscitation commenced with positive pressure ventilation followed by chest compressions and lambs received either intraosseous or central intravenous adrenaline (10 micrograms/kg); adrenaline administration was repeated every 3 minutes until return of spontaneous circulation (ROSC). Lambs were maintained for 30 minutes after ROSC. Plasma adrenaline levels were measured before cord clamping, at end asphyxia, and at 3 and 15 minutes post-ROSC.
Results: ROSC was successful in 7/9 intraosseous adrenaline lambs and 10/12 intravenous adrenaline lambs. The time and number of adrenaline doses required to achieve ROSC were similar between groups, as were the achieved plasma adrenaline levels. Lambs in both groups displayed a similar marked overshoot in systemic blood pressure and carotid blood flow after ROSC. Blood gas parameters improved more quickly in the intraosseous lambs in the first 3 minutes, but were otherwise similar over the 30 minutes after ROSC.
Conclusions: Intraosseous adrenaline administration results in similar outcomes to intravenous adrenaline during resuscitation of asphyxiated newborn lambs. These findings support the inclusion of intraosseous access as a route for adrenaline administration in current guidelines.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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- Files:
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(Preview, Accepted manuscript, pdf, 223.4KB, Terms of use)
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- Publisher copy:
- 10.1136/archdischild-2021-322638
Authors
- Publisher:
- BMJ Publishing Group
- Journal:
- Archives of Disease in Childhood More from this journal
- Volume:
- 107
- Issue:
- 3
- Pages:
- 311-316
- Publication date:
- 2021-08-30
- Acceptance date:
- 2021-08-12
- DOI:
- EISSN:
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1468-2044
- ISSN:
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0003-9888
- Language:
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English
- Keywords:
- Pubs id:
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1193978
- Local pid:
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pubs:1193978
- Deposit date:
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2021-09-08
- ARK identifier:
Terms of use
- Copyright holder:
- Roberts et al.
- Copyright date:
- 2021
- Rights statement:
- © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.
- Notes:
- This is the accepted manuscript version of the article. The final version is available online from BMJ Publishing Group at: http://dx.doi.org/10.1136/archdischild-2021-322638
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