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Mil Med. 2014 Jan;179(1):99-104. doi: 10.7205/MILMED-D-13-00231.

An evidence-based review of epinephrine administered via the intraosseous route in animal models of cardiac arrest.

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  • 1U.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.
  • 2Texas Wesleyan University, 14311 Harvest Moon Road, Boyds, MD 20841.



Intraosseous (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.


The 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.


Four 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.


The 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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