Skip to main content

Special Populations: Cardiac Arrest

  • Chapter
  • First Online:
Emergent Vascular Access

Abstract

This chapter provides the reader with an introduction to the management of emergent vascular access for patients experiencing cardiac arrest. Special attention is paid to difficulties arising as a result of the emergent nature of cardiac arrest resuscitation, including difficulties in generating adequate organ and limb perfusion. Available vascular access techniques are discussed, including the evidence for preferring one vascular access device over another. A potential algorithm for managing emergent vascular access for this clinical condition is described.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Panchal AR, Bartos JA, Cabanas JG, et al. Part 3: adult basic and advanced life support. 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020;142(Suppl2):S366–468.

    PubMed  Google Scholar 

  2. Jacobs IG, Finn JC, Jelinek GA, et al. Effect of adrenaline on survival in out-of-hospital cardiac arrest: a randomised double-blind placebo-controlled trial. Resuscitation. 2011;82:1138–43.

    Article  CAS  PubMed  Google Scholar 

  3. Perkins GD, Ji C, Deakin CD, et al. A randomized trial of epinephrine in out-of-hospital cardiac arrest. N Engl J Med. 2018;379:711–21.

    Article  CAS  PubMed  Google Scholar 

  4. Halperin HR, Tsitlik JE, Gelfand M, et al. A preliminary study of cardiopulmonary resuscitation by circumferential compression of the chest with use of a pneumatic vest. N Engl J Med. 1993;329:762–8.

    Article  CAS  PubMed  Google Scholar 

  5. Weisfeldt ML, Becker LB. Resuscitation after cardiac arrest: a 3-phase time-sensitive model. JAMA. 2002;288:3035–8.

    Article  PubMed  Google Scholar 

  6. Hoek TLV, Becker LB, Shao Z, et al. Reactive oxygen species released from mitochondria during brief hypoxia induce preconditioning in cardiomyocytes. J Biol Chem. 1998;273:18092–8.

    Article  Google Scholar 

  7. Hoek TLV, Becker LB, Shao ZH, et al. Preconditioning in cardiomyocytes protects by attenuating oxidant stress at reperfusion. Circ Res. 2000;86:541–8.

    Article  Google Scholar 

  8. Cobb LA, Fahrenbruch CE, Olsufka M, Copass MK. Changing incidence of out-of-hospital ventricular fibrillation, 1980–2000. JAMA. 2002;288:3008–13.

    Article  PubMed  Google Scholar 

  9. Nolan JP, Perkins GD. Is there a role for adrenaline during cardiopulmonary resuscitation? Curr Opin Crit Care. 2013;19:169–74.

    Article  PubMed  Google Scholar 

  10. Kudenchuk PJ, Sandroni C, Drinhaus HR, et al. Breakthrough in cardiac arrest: reports from the 4th Paris international conference. Ann Intensive Care. 2015;5:22.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  11. Cummins RO, Ornato JP, Thies WH, et al. Improving survival from sudden cardiac arrest: the “chain of survival” concept. A statement for health professionals from the Advanced Cardiac Life Support Subcommittee and the Emergency Cardiac Care Committee, American Heart Association. Circulation. 1991 May;83(5):1832–47.

    Article  CAS  PubMed  Google Scholar 

  12. Link MS, Berkow LC, Kudenchuk PJ, et al. Part 7: Adult Advanced Cardiovascular Life Support. 2015 American heart Association Guidelines Update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132(suppl 2):S444–64.

    PubMed  Google Scholar 

  13. Panchal AR, Berg KM, Hirsch KG, et al. 2019 American Heart Association Focused Update on Advanced Cardiovascular Life Support: use of advanced airways, vasopressors, and extracorporeal cardiopulmonary resuscitation during cardiac arrest: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2019;140:e881–94.

    PubMed  Google Scholar 

  14. Hagihara A, Hasegawa M, Abe T, et al. Prehospital epinephrine use and survival among patients with out-of-hospital cardiac arrest. JAMA. 2012;307(11):1161–8.

    Article  CAS  PubMed  Google Scholar 

  15. Bendixen HH, Laver MB, Flacke WE. Influence of respiratory acidosis on circulatory effect of epinephrine in dogs. Circ Research. 1963;13(1):64.

    Article  CAS  Google Scholar 

  16. Angelos MG, Butke RL, Panchal AR, et al. Cardiovascular reponse to epinephrine varies with increasing duration of cardiac arrest. Resuscitation. 2008;77:101–10.

    Article  CAS  PubMed  Google Scholar 

  17. Van Walraven C, Stiell IG, Wells GA, et al. Do advanced cardiac life support drugs increase resuscitation rates from in-hospital cardiac arrest? The OTAC Study Group. Ann Emerg Med. 1998;32(5):544–53.

    Article  PubMed  Google Scholar 

  18. Macht DI. Studies on intraosseous injection of epinephrine. Am J Physiol. 1943:269–72.

    Google Scholar 

  19. Spivey WH, Crespo SG, Fuhs LR, Schoffstall JM. Plasma catecholamine levels after intraosseous epinephrine administration in a cardiac arrest model. Ann Emerg Med. 1992;21(2):127–31.

    Article  CAS  PubMed  Google Scholar 

  20. Zuercher M, Kern KB, Indik JH, et al. Epinephrine improves 24-hour survival in a swine model of prolonged ventricular fibrillation demonstrating that early intraosseous is superior to delayed intravenous administration. Anesth Analg. 2011;112:884–90.

    Article  CAS  PubMed  Google Scholar 

  21. Burgert J, Gegel B, Loughren M, et al. Comparison of tibial intraosseous, sternal intraosseous, and intravenous routes of administration on pharmacokinetics of epinephrine during cardiac arrest: a pilot study. AANA J. 2012;80(4):S6–S10.

    PubMed  Google Scholar 

  22. Burgert J, Gegel BT, Johnson D. The pharmacokinetics of intravenous, tibial intraosseous and sternal intraosseous epinephrine during cardiopulmonary resuscitation in a swine model of cardiac arrest. Minerva Med. 2014;105(2 Suppl 1):35.

    Google Scholar 

  23. Dorian P, Cass D, Schwartz B, et al. Amiodarone as compared with lidocaine for shock-resistant ventricular fibrillation. N Engl J Med. 2002;346(12):884–990.

    Article  CAS  PubMed  Google Scholar 

  24. Daya MR, Leroux BG, Dorian P, et al. Survival after intravenous versus intraosseous amiodarone, lidocaine, or placebo in out-of-hospital shock-refractory cardiac arrest. Circulation. 2020;141(3):188–98.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Kudenchuk PJ, Cobb LA, Copass MK, et al. Amiodarone for resuscitation after out-of-hospital cardiac arrest due to ventricular fibrillation. N Engl J Med. 1999;341(12):871–8.

    Article  CAS  PubMed  Google Scholar 

  26. Tzivoni D, Banai S, Schuger C, et al. Treatment of torsade de pointes with magnesium sulfate. Circulation. 1988;77:392–7.

    Article  CAS  PubMed  Google Scholar 

  27. Manz M, Pfeiffer D, Jung W, Lueritz B. Intravenous treatment with magnesium in recurrent persistent ventricular tachycardia. N Trends Arrhythmias. 1991;7:437–42.

    Google Scholar 

  28. Bar-Joseph G, Abramson NS, Kelsey SF, et al. Brain Resuscitation Clinical Trial III (BRCT III) Study Group: improved resuscitation outcome in emergency medical systems with increased usage of sodium bicarbonate during cardiopulmonary resuscitation. Acta Anaesthesiol Scand. 2005;49(1):6–15.

    Article  CAS  PubMed  Google Scholar 

  29. Thrower WB, Darby TD, Aldinger EE. Studies of the relationship between sympatho-adrenal function, acid-base derangements and ventricular contractile force. Surg Forum. 1960;10:535.

    CAS  PubMed  Google Scholar 

  30. Von Hoff DD, Kuhn JG, Burris HA III, Miller LJ. Does intraosseous equal intravenous? A pharmacokinetic study. Am J Emerg Med. 2008;26(1):31–8.

    Article  Google Scholar 

  31. Berg RA. Emergency infusion of catecholamines into bone marrow. Am J Dis Child. 1984;138(9):810–1.

    CAS  PubMed  Google Scholar 

  32. McNamara RM, Spivey WH, Unger HD, Malone DR. Emergency applications of intraosseous infusion. J Emerg Med. 1987;5:97–101.

    Article  CAS  PubMed  Google Scholar 

  33. Spivey WH. Intraosseous infusions. J Pediatr. 1987;111:639–43.

    Article  CAS  PubMed  Google Scholar 

  34. Brunette DD, Fischer R. Intravenous access in pediatric cardiac arrest. Am J Emerg Med. 1998;6:577–9.

    Article  Google Scholar 

  35. Glaeser PW, Hellmich TR, Szewczuga D, Losek JD, Smith DS. Five-year experience in prehospital intraosseous infusions in children and adults. Ann Emerg Med. 1993;22:1119–24.

    Article  CAS  PubMed  Google Scholar 

  36. Guy J, Haley K, Zuspan SJ. Use of intraosseous infusion in the pediatric trauma patient. J Ped Surg. 1993;28(2):158–61.

    Article  CAS  Google Scholar 

  37. Davidoff J, Fowler R, Gordon D, et al. Clinical evaluation of a novel intraosseous device for adults: prospective, 250–patient, multi-center trial. JEMS. 2005;30(10):s20–3.

    Google Scholar 

  38. Fiorito BA, Mirza F, Doran TM, et al. Intraosseous access in the setting of pediatric critical care transport. Pediatr Crit Care Med. 2005;6(1):50–3.

    Article  PubMed  Google Scholar 

  39. Valdes M, Araujo P, de Andres C, et al. Intraosseous administration of thrombolysis in out-of-hospital massive pulmonary thromboembolism. Emerg Med J. 2010;27(8):641–4.

    Article  PubMed  Google Scholar 

  40. Gazin N, Auger H, Jabre P, et al. Efficacy and safety of the EZ-IO intraosseous device: out-of-hospital implementation of a management algorithm for difficult vascular access. Resuscitation. 2011;82:126–9.

    Article  PubMed  Google Scholar 

  41. Vorhees WD, Babbs CF, Tacker WA. Regional blood flow during CPR in dogs. Crit Care Med. 1980;8:134.

    Article  Google Scholar 

  42. Del Guercio LRM, Coomarswamy RP, State D. Cardiac output and other hemodynamic variables during external cardiac massage in man. N Engl J Med. 1963;269:1398.

    Article  Google Scholar 

  43. Oriol A, Smith HJ. Hemodynamic observations during cardiac massage. J Can Med Assoc. 1968;98:841.

    CAS  Google Scholar 

  44. Kuhn GJ, White BC, Swetnam RE, et al. Peripheral vs central circulation times during CPR: a pilot study. Ann Emerg Med. 1981;10(8):417–9.

    Article  CAS  PubMed  Google Scholar 

  45. Leidel BA, Kirchhoff C, Bogner V, et al. Comparison of intraosseous versus central venous vascular access in adults under resuscitation in the emergency department with inaccessible peripheral veins. Resuscitation. 2012;83(1):40–5.

    Article  PubMed  Google Scholar 

  46. Paxton JH, Knuth TE, Klausner HA. Proximal humerus intraosseous infusion: a preferred emergency venous access. J Trauma. 2009;67(3):606–11.

    PubMed  Google Scholar 

  47. Reades R, Studnek JR, Vandeventer S, Garrett J. Intraosseous versus intravenous vascular access during out-of-hospital cardiac arrest: a randomized controlled trial. Ann Emerg Med. 2011;58(6):509–16.

    Article  PubMed  Google Scholar 

  48. Feinstein BA, Stubbs BA, Rea T, et al. Intraosseous compared to intravenous drug resuscitation in out-of-hospital cardiac arrest. Resuscitation. 2017;117:91–6.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sarah Meram .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Meram, S., Falcon, T., Paxton, J.H. (2021). Special Populations: Cardiac Arrest. In: Paxton, J.H. (eds) Emergent Vascular Access. Springer, Cham. https://doi.org/10.1007/978-3-030-77177-5_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-77177-5_9

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-77176-8

  • Online ISBN: 978-3-030-77177-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics