Peripheral vs. Central Circulation Times during Cardiopulmonary Resuscitation: A Pilot Study

Kuhn CJ, White BC, Swetnam RE, et al. Annals of Emergency Medicine 1981 Vol 10 Pages 417-419

Advanced resuscitation techniques are dependent on drug therapy to increase survival and reduce morbidity. Because drugs must reach their site of action instantaneously, the choice of an appropriate route of administration may be critical; however, there is little data regarding choice of the most efficacious route during advanced life support utilizing CPR. During resuscitation, drugs may be administered through the endotracheal, intracardiac, or intravenous routes. The intravenous route may be peripheral or central. If there is a significant difference among IV sites in drug transit times to the central circulation, the choice of the IV site during resuscitation could be a crucial management decision. The authors addressed two questions: 1) Do drugs injected through a peripheral site reach the central circulation within an acceptable period of time? 2) Does central venous injection afford a significant advantage in drug transit time? The study was conducted in the Department of Emergency Medicine at Providence Hospital in Southfield, Michigan. The study group consisted of six patients who had unsuccessful resuscitation attempts. Investigation was initiated after resuscitation attempts were terminated. The circulation time during closed chest cardiac compression was studied using Cardio-Green dye injected in either the right antecubital vein or right subclavian vein during CPR. Arterial blood was obtained from a right femoral arterial catheter at 30-second intervals for five minutes following injection. The arterial sample after central venous injection revealed a high concentration of the dye at 30 seconds and an emerging second peak at five minutes. After peripheral injection, no dye appeared until 90 seconds after injection, and no peak concentration of the dye was achieved during the five-minute sampling period. The authors recognize that the data from such a small group is open to criticism, but suggest that this preliminary study indicates reduced concentration and significant delay in arrival of injected agents that are introduced at a peripheral intravenous site during closed chest cardiac compression. Given the imperative for drug arrival in the central arterial circulation during resuscitation, the date provides a preliminary basis for the routine establishment of central venous Ivs in all patients requiring advanced cardiac life support.