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Weitman M, Eisenkraft A, TaShma Z, Makarovsky I, Last D, Daniels D, Guez D, Shneor R, Mardor Y, Nudelman A, Krivoy A. Synthesis and preliminary biological evaluation of gabactyzine, a benactyzine-GABA mutual prodrug, as an organophosphate antidote. Sci Rep 2022; 12:18078. [PMID: 36302937 PMCID: PMC9613653 DOI: 10.1038/s41598-022-23141-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/25/2022] [Indexed: 01/09/2023] Open
Abstract
Organophosphates (OPs) are inhibitors of acetylcholinesterase and have deleterious effects on the central nervous system. Clinical manifestations of OP poisoning include convulsions, which represent an underlying toxic neuro-pathological process, leading to permanent neuronal damage. This neurotoxicity is mediated through the cholinergic, GABAergic and glutamatergic (NMDA) systems. Pharmacological interventions in OP poisoning are designed to mitigate these specific neuro-pathological pathways, using anticholinergic drugs and GABAergic agents. Benactyzine is a combined anticholinergic, anti-NMDA compound. Based on previous development of novel GABA derivatives (such as prodrugs based on perphenazine for the treatment of schizophrenia and nortriptyline against neuropathic pain), we describe the synthesis and preliminary testing of a mutual prodrug ester of benactyzine and GABA. It is assumed that once the ester crosses the blood-brain-barrier it will undergo hydrolysis, releasing benactyzine and GABA, which are expected to act synergistically. The combined release of both compounds in the brain offers several advantages over the current OP poisoning treatment protocol: improved efficacy and safety profile (where the inhibitory properties of GABA are expected to counteract the anticholinergic cognitive adverse effects of benactyzine) and enhanced chemical stability compared to benactyzine alone. We present here preliminary results of animal studies, showing promising results with early gabactyzine administration.
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Affiliation(s)
- Michal Weitman
- grid.22098.310000 0004 1937 0503Chemistry Department, Bar Ilan University, 52900 Ramat Gan, Israel
| | - Arik Eisenkraft
- grid.9619.70000 0004 1937 0538The Institute for Research in Military Medicine, The Hebrew University Faculty of Medicine and The IDF Medical Corps, Jerusalem, Israel ,The IDF Medical Corps Headquarters, Ramat Gan, Israel
| | - Zeev TaShma
- The IDF Medical Corps Headquarters, Ramat Gan, Israel
| | - Igor Makarovsky
- grid.22098.310000 0004 1937 0503Chemistry Department, Bar Ilan University, 52900 Ramat Gan, Israel
| | - David Last
- grid.413795.d0000 0001 2107 2845The Advanced Technology Center, Sheba Medical Center, Ramat-Gan, Israel
| | - Dianne Daniels
- grid.413795.d0000 0001 2107 2845The Advanced Technology Center, Sheba Medical Center, Ramat-Gan, Israel
| | - David Guez
- grid.413795.d0000 0001 2107 2845The Advanced Technology Center, Sheba Medical Center, Ramat-Gan, Israel
| | - Ran Shneor
- grid.413795.d0000 0001 2107 2845The Advanced Technology Center, Sheba Medical Center, Ramat-Gan, Israel
| | - Yael Mardor
- grid.413795.d0000 0001 2107 2845The Advanced Technology Center, Sheba Medical Center, Ramat-Gan, Israel ,grid.12136.370000 0004 1937 0546Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Abraham Nudelman
- grid.22098.310000 0004 1937 0503Chemistry Department, Bar Ilan University, 52900 Ramat Gan, Israel
| | - Amir Krivoy
- The IDF Medical Corps Headquarters, Ramat Gan, Israel ,grid.415340.70000 0004 0403 0450Geha Mental Health Center, Petach-Tikva, Israel
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Drozd A, Wolska M, Szarpak L. Intraosseous vascular access in emergency and trauma settings: a comparison of the most universally used intraosseous devices. Expert Rev Med Devices 2021; 18:855-864. [PMID: 34325586 DOI: 10.1080/17434440.2021.1962287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction: Obtaining successful vascular access is an essential component of the emergency and trauma setting. The modern practice of medicine advocates IO access for patients in a critical condition, especially when IV access is problematic or unobtainable. Various medical devices allowing for IO access have been coined and used in the management of critical patients.Areas covered: This study aims to review the literature regarding different intraosseous devices used to obtain vascular access (Bone Injection Gun (BIG), EZ-IO, NIO, Jamshidi, and First Access for Shock and Trauma (FAST-1) and discuss their clinical and experimental role in the emergency and trauma settings.Expert opinion: The development of medical technology contributes to an increasing number of intraosseous devices facilitating vascular access in challenging scenarios, including cardiopulmonary resuscitation, anaphylactic, or hypovolemic shock. Each of these devices provides an effective route for fluid resuscitation, drug delivery, laboratory evaluation, and shortening the timeframe for established vascular access, provided that the person obtaining the access is acquainted with the use of the device.
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Affiliation(s)
- Anna Drozd
- Outcomes Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland
| | - Marta Wolska
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, Warsaw, Poland
| | - Lukasz Szarpak
- Outcomes Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland.,Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy in Warsaw, Warsaw, Poland.,Outcomes Research Unit, Maria Sklodowska-Curie Bialystok Oncology Center, Bialystok, Poland
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Uwaydah NI, Hoskins SL, Bruttig SP, Farrar H, Copper NC, Deyo DJ, Dubick MA, Kramer GC. Intramuscular versus Intraosseous Delivery of Nerve Agent Antidote Pralidoxime Chloride in Swine. PREHOSP EMERG CARE 2016; 20:485-92. [PMID: 27158860 DOI: 10.3109/10903127.2014.942479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Exposure to nerve agents requires prompt treatment. We hypothesized that intraosseous (IO) injections of drug antidotes into the vascularized bone marrow will provide a more rapid and effective means to treat exposure to nerve agents than standard intramuscular (IM) injections. We compared the pharmacokinetics of IM and IO administration of pralidoxime chloride (2-PAM Cl) during normovolemia and hypovolemia, as well as their combined administration during normovolemia in swine. METHODS Ten normovolemic swine were randomly administered 2 mL, 660 mg 2-PAM Cl via the IM or IO route and monitored for 180 minutes. IM versus IO also was compared in 8 hypovolemic swine bled to a mean arterial pressure of 50 mmHg. In a combined group, an IO injection was administered followed by an IM injection 60 minutes later. Blood samples were collected at times over a 180-minute period to calculate standard pharmacokinetic variables to compare the 2 routes of administration. RESULTS In the normovolemic swine, IM injection achieved therapeutic levels (4 μg/mL) in 2 minutes, whereas IO infusion achieved these levels in less than 15 seconds. 2-PAM-Cl concentrations fell below these levels at 60 minutes post-injection in both groups. In the hypovolemic swine, IM injection achieved therapeutic levels in 4 minutes compared to less than 15 seconds in the IO group. 2-PAM-Cl concentrations fell below therapeutic levels at 12 and 90 minutes post-injection in the IM and IO groups, respectively. In the combined IO-IM treatment, plasma levels remained above therapeutic levels for the entire experiment and had two concentration peaks that corresponded to IO and IM injections. CONCLUSIONS The IO route for the delivery of 2-PAM Cl provides a significant time and high initial blood concentrations advantage compared to the IM route for the prehospital treatment of nerve agent exposure even under hypovolemic conditions. The initial concentration peak associated with IO, but not IM, may provide greater initial therapy at the most critical time.
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Eisenkraft A, Falk A. The possible role of intravenous lipid emulsion in the treatment of chemical warfare agent poisoning. Toxicol Rep 2016; 3:202-210. [PMID: 28959540 PMCID: PMC5615427 DOI: 10.1016/j.toxrep.2015.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 11/29/2015] [Accepted: 12/24/2015] [Indexed: 12/19/2022] Open
Abstract
Organophosphates (OPs) are cholinesterase inhibitors that lead to a characteristic toxidrome of hypersecretion, miosis, dyspnea, respiratory insufficiency, convulsions and, without proper and early antidotal treatment, death. Most of these compounds are highly lipophilic. Sulfur mustard is a toxic lipophilic alkylating agent, exerting its damage through alkylation of cellular macromolecules (e.g., DNA, proteins) and intense activation of pro-inflammatory pathways. Currently approved antidotes against OPs include the peripheral anticholinergic drug atropine and an oxime that reactivates the inhibited cholinesterase. Benzodiazepines are used to stop organophosphate-induced seizures. Despite these approved drugs, efforts have been made to introduce other medical countermeasures in order to attenuate both the short-term and long-term clinical effects following exposure. Currently, there is no antidote against sulfur mustard poisoning. Intravenous lipid emulsions are used as a source of calories in parenteral nutrition. In recent years, efficacy of lipid emulsions has been shown in the treatment of poisoning by fat-soluble compounds in animal models as well as clinically in humans. In this review we discuss the usefulness of intravenous lipid emulsions as an adjunct to the in-hospital treatment of chemical warfare agent poisoning.
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Affiliation(s)
- Arik Eisenkraft
- NBC Protection Division, IMOD, Israel.,Israel Defense Forces Medical Corps, Israel.,The Institute for Research in Military Medicine, The Faculty of Medicine, The Hebrew University, Jerusalem, Israel
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Maconochie IK, Bingham R, Eich C, López-Herce J, Rodríguez-Núñez A, Rajka T, Van de Voorde P, Zideman DA, Biarent D, Monsieurs KG, Nolan JP. European Resuscitation Council Guidelines for Resuscitation 2015. Resuscitation 2015; 95:223-48. [DOI: 10.1016/j.resuscitation.2015.07.028] [Citation(s) in RCA: 217] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Gur I, Shapira S, Katalan S, Rosner A, Baranes S, Grauer E, Moran-Gilad J, Eisenkraft A. Biphasic cuirass ventilation is better than bag-valve mask ventilation for resuscitation following organophosphate poisoning. Toxicol Rep 2014; 2:40-45. [PMID: 28962335 PMCID: PMC5598215 DOI: 10.1016/j.toxrep.2014.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 11/01/2014] [Accepted: 11/01/2014] [Indexed: 11/28/2022] Open
Abstract
Objective Exposure to organophosphates (OP) may lead to a life threatening cholinergic crisis with death attributed to a rapidly progressive respiratory failure. In a toxicological mass casualty event involving organophosphate exposure, many of the victims may depend on immediate short-term ventilation to overcome the respiratory distress which may exhaust life supporting resources. In addition, the mandatory use of personal protective gear by first responders emphasizes the need for a noninvasive, easy-to-operate ventilation device. Our objective was to assess the efficacy of MRTX, a Biphasic Cuirass Ventilation device, in comparison with standard bag-valve mask ventilation following acute organophosphate poisoning. Methods Pigs were exposed to paraoxon poisoning (1.4 LD50), and treated 8 min later with atropine (0.05 mg/kg). The control group received no further support (n = 9), the two experimental groups received ventilation support initiated 15 min post exposure and lasted for 25 min: one group was ventilated with the commonly used bag-valve mask (Mask group, n = 7) and the other was ventilated with the Biphasic Cuirass Ventilation device (Cuirass group, n = 7). Clinical signs and physiological parameters were monitored during the first hour, and mortality up to 24 h post exposure was recorded. Results No mortality was observed in the Cuirass group following OP poisoning, while mortality in the Control and in the Mask groups was high (67% and 71%, respectively). Mouth excretions of the cuirass-ventilated animals were frothy white as in deep suctioning, as opposed to the clear saliva-like appearance of secretions in the other two groups. No further group differences were recorded. Conclusions The noninvasive, easy-to-operate Biphasic Cuirass Ventilation device was effective in reducing OP-induced mortality and might be advantageous in an organophosphate mass casualty event. This finding should be validated in further investigations.
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Affiliation(s)
- Ilan Gur
- Bikur Holim Hospital, Jerusalem, Israel
| | - Shlomo Shapira
- Israel Institute for Biological Research, Ness-Ziona, Israel
| | - Shahaf Katalan
- Israel Institute for Biological Research, Ness-Ziona, Israel
| | - Amir Rosner
- Israel Institute for Biological Research, Ness-Ziona, Israel
| | - Shlomo Baranes
- Israel Institute for Biological Research, Ness-Ziona, Israel
| | - Ettie Grauer
- Israel Institute for Biological Research, Ness-Ziona, Israel
| | | | - Arik Eisenkraft
- IDF Medical Corps, Ramat Gan, Israel.,NBC Protection Division, IMOD, Tel-Aviv, Israel.,The Institute for Research in Military Medicine (IRMM), The Faculty of Medicine, The Hebrew University, Jerusalem, Israel
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Dorandeu F, Dhote F, Barbier L, Baccus B, Testylier G. Treatment of status epilepticus with ketamine, are we there yet? CNS Neurosci Ther 2013; 19:411-27. [PMID: 23601960 PMCID: PMC6493567 DOI: 10.1111/cns.12096] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 02/23/2013] [Accepted: 02/23/2013] [Indexed: 12/24/2022] Open
Abstract
Status epilepticus (SE), a neurological emergency both in adults and in children, could lead to brain damage and even death if untreated. Generalized convulsive SE (GCSE) is the most common and severe form, an example of which is that induced by organophosphorus nerve agents. First- and second-line pharmacotherapies are relatively consensual, but if seizures are still not controlled, there is currently no definitive data to guide the optimal choice of therapy. The medical community seems largely reluctant to use ketamine, a noncompetitive antagonist of the N-methyl-d-aspartate glutamate receptor. However, a review of the literature clearly shows that ketamine possesses, in preclinical studies, antiepileptic properties and provides neuroprotection. Clinical evidences are scarcer and more difficult to analyze, owing to a use in situations of polytherapy. In absence of existing or planned randomized clinical trials, the medical community should make up its mind from well-conducted preclinical studies performed on appropriate models. Although potentially active, ketamine has no real place for the treatment of isolated seizures, better accepted drugs being used. Its best usage should be during GCSE, but not waiting for SE to become totally refractory. Concerns about possible developmental neurotoxicity might limit its pediatric use for refractory SE.
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Affiliation(s)
- Frederic Dorandeu
- Département de Toxicologie et risques chimiques, Institut de Recherche Biomédicale des Armées - Centre de Recherches du Service de Santé des Armées (IRBA-CRSSA), La Tronche Cedex, France.
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Eisenkraft A, Falk A, Finkelstein A. The role of glutamate and the immune system in organophosphate-induced CNS damage. Neurotox Res 2013; 24:265-79. [PMID: 23532600 DOI: 10.1007/s12640-013-9388-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 03/10/2013] [Accepted: 03/15/2013] [Indexed: 12/12/2022]
Abstract
Organophosphate (OP) poisoning is associated with long-lasting neurological damage, which is attributed mainly to the excessive levels of glutamate caused by the intoxication. Glutamate toxicity, however, is not specific to OP poisoning, and is linked to propagation of damage in both acute and chronic neurodegenerative conditions in the central nervous system (CNS). In addition to acute excitotoxic effects of glutamate, there is now a growing amount of evidence of its intricate immunomodulatory effects in the brain, involving both the innate and the adaptive immune systems. Moreover, it was demonstrated that immunomodulatory treatments, aimed at regulating the interaction between the resident immune cells of the brain (microglia) and the peripheral immune system, can support buffering of excessive levels of glutamate and restoration of the homeostasis. In this review, we will discuss the role of glutamate as an excitotoxic agent in the acute phase of OP poisoning, and the possible functions it may have as both a neuroprotectant and an immunomodulator in the sub-acute and chronic phases of OP poisoning. In addition, we will describe the novel immune-based neuroprotective strategies aimed at counteracting the long-term neurodegenerative effects of glutamate in the CNS.
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Rapid and Complete Bioavailability of Antidotes for Organophosphorus Nerve Agent and Cyanide Poisoning in Minipigs After Intraosseous Administration. Ann Emerg Med 2012; 60:424-30. [DOI: 10.1016/j.annemergmed.2012.05.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Revised: 05/01/2012] [Accepted: 05/09/2012] [Indexed: 11/20/2022]
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Finkelstein A, Kunis G, Berkutzki T, Ronen A, Krivoy A, Yoles E, Last D, Mardor Y, Van Shura K, McFarland E, Capacio BA, Eisner C, Gonzales M, Gregorowicz D, Eisenkraft A, McDonough JH, Schwartz M. Immunomodulation by poly-YE reduces organophosphate-induced brain damage. Brain Behav Immun 2012; 26:159-69. [PMID: 21925261 DOI: 10.1016/j.bbi.2011.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 09/01/2011] [Indexed: 10/17/2022] Open
Abstract
Accidental organophosphate poisoning resulting from environmental or occupational exposure, as well as the deliberate use of nerve agents on the battlefield or by terrorists, remain major threats for multi-casualty events, with no effective therapies yet available. Even transient exposure to organophosphorous compounds may lead to brain damage associated with microglial activation and to long-lasting neurological and psychological deficits. Regulation of the microglial response by adaptive immunity was previously shown to reduce the consequences of acute insult to the central nervous system (CNS). Here, we tested whether an immunization-based treatment that affects the properties of T regulatory cells (Tregs) can reduce brain damage following organophosphate intoxication, as a supplement to the standard antidotal protocol. Rats were intoxicated by acute exposure to the nerve agent soman, or the organophosphate pesticide, paraoxon, and after 24 h were treated with the immunomodulator, poly-YE. A single injection of poly-YE resulted in a significant increase in neuronal survival and tissue preservation. The beneficial effect of poly-YE treatment was associated with specific recruitment of CD4(+) T cells into the brain, reduced microglial activation, and an increase in the levels of brain derived neurotrophic factor (BDNF) in the piriform cortex. These results suggest therapeutic intervention with poly-YE as an immunomodulatory supplementary approach against consequences of organophosphate-induced brain damage.
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Affiliation(s)
- Arseny Finkelstein
- Department of Neurobiology, The Weizmann Institute of Science, Rehovot 76100, Israel
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Borron SW, Arias JC, Bauer CR, Philbeck T, Hass P, Lawson W, Montez D, Fernández M, Jung I, Gordon DJ. Intraosseous line placement for antidote injection by first responders and receivers wearing personal protective equipment. Am J Emerg Med 2011; 29:373-81. [DOI: 10.1016/j.ajem.2009.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Revised: 10/22/2009] [Accepted: 10/24/2009] [Indexed: 11/24/2022] Open
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Biarent D, Bingham R, Eich C, López-Herce J, Maconochie I, Rodríguez-Núñez A, Rajka T, Zideman D. European Resuscitation Council Guidelines for Resuscitation 2010 Section 6. Paediatric life support. Resuscitation 2011; 81:1364-88. [PMID: 20956047 DOI: 10.1016/j.resuscitation.2010.08.012] [Citation(s) in RCA: 151] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Dominique Biarent
- Paediatric Intensive Care, Hôpital Universitaire des Enfants, 15 av JJ Crocq, Brussels, Belgium.
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Biarent D, Bingham R, Eich C, López-Herce J, Maconochie I, Rodrίguez-Núñez A, Rajka T, Zideman D. Lebensrettende Maßnahmen bei Kindern („paediatric life support“). Notf Rett Med 2010. [DOI: 10.1007/s10049-010-1372-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Leidel BA, Kirchhoff C, Bogner V, Stegmaier J, Mutschler W, Kanz KG, Braunstein V. Is the intraosseous access route fast and efficacious compared to conventional central venous catheterization in adult patients under resuscitation in the emergency department? A prospective observational pilot study. Patient Saf Surg 2009; 3:24. [PMID: 19814822 PMCID: PMC2764565 DOI: 10.1186/1754-9493-3-24] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Accepted: 10/08/2009] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND For patients' safety reasons, current American Heart Association and European Resuscitation Council guidelines recommend intraosseous (IO) vascular access as an alternative in cases of emergency, if prompt venous catheterization is impossible. The purpose of this study was to compare the IO access as a bridging procedure versus central venous catheterization (CVC) for in-hospital adult emergency patients under resuscitation with impossible peripheral intravenous (IV) access. We hypothesised, that CVC is faster and more efficacious compared to IO access. METHODS A prospective observational study comparing success rates and procedure times of IO access (EZ-IO, Vidacare Corporation) versus CVC in adult (>/=18 years of age) patients under trauma and medical resuscitation admitted to our emergency department with impossible peripheral IV catheterization was conducted. Procedure time was defined from preparation and insertion of vascular access type until first drug or infusion solution administration. Success rate on first attempt and procedure time for each access route was evaluated and statistically tested. RESULTS Ten consecutive adult patients under resuscitation, each receiving IO access and CVC, were analyzed. IO access was performed with 10 tibial or humeral insertions, CVC in 10 internal jugular or subclavian veins. The success rate on first attempt was 90% for IO insertion versus 60% for CVC. Mean procedure time was significantly lower for IO cannulation (2.3 min +/- 0.8) compared to CVC (9.9 min +/- 3.7) (p < 0.001). As for complications, failure of IO access was observed in one patient, while two or more attempts of CVC were necessary in four patients. No other relevant complications, like infection, bleeding or pneumothorax were observed. CONCLUSION Preliminary data demonstrate that IO access is a reliable bridging method to gain vascular access for in-hospital adult emergency patients under trauma or medical resuscitation with impossible peripheral IV access. Furthermore, IO cannulation requires significantly less time to enable administration of drugs or infusion solutions compared to CVC. Because CVC was slower and less efficacious, IO access may improve the safety of adult patients under resuscitation in the emergency department.
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Affiliation(s)
- Bernd A Leidel
- Department of Emergency Medicine, Charité - University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
- Helicopter Emergency Medical Service Christoph 31, ADAC Luftrettung air rescue services, Charité - University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Chlodwig Kirchhoff
- Department of Trauma, University Medical Centre of Munich, Downtown, Nussbaum Street 20, 80336 Munich, Germany
| | - Viktoria Bogner
- Department of Trauma, University Medical Centre of Munich, Downtown, Nussbaum Street 20, 80336 Munich, Germany
| | - Julia Stegmaier
- Department of Trauma, University Medical Centre of Munich, Downtown, Nussbaum Street 20, 80336 Munich, Germany
| | - Wolf Mutschler
- Department of Trauma, University Medical Centre of Munich, Downtown, Nussbaum Street 20, 80336 Munich, Germany
| | - Karl-Georg Kanz
- Department of Trauma, University Medical Centre of Munich, Downtown, Nussbaum Street 20, 80336 Munich, Germany
| | - Volker Braunstein
- Department of Trauma, University Medical Centre of Munich, Downtown, Nussbaum Street 20, 80336 Munich, Germany
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