RT Journal Article SR Electronic T1 Comparison of intraosseous and intravenous epinephrine administration during resuscitation of asphyxiated newborn lambs JF Archives of Disease in Childhood - Fetal and Neonatal Edition JO Arch Dis Child Fetal Neonatal Ed FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health SP fetalneonatal-2021-322638 DO 10.1136/archdischild-2021-322638 A1 Calum T Roberts A1 Sarah Klink A1 Georg M Schmölzer A1 Douglas A Blank A1 Shiraz Badurdeen A1 Kelly J Crossley A1 Karyn Rodgers A1 Valerie Zahra A1 Alison Moxham A1 Charles Christoph Roehr A1 Martin Kluckow A1 Andrew William Gill A1 Stuart B Hooper A1 Graeme R Polglase YR 2021 UL http://fn.bmj.com/content/early/2021/09/28/archdischild-2021-322638.abstract AB 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 epinephrine 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 the lambs received either intraosseous or central intravenous epinephrine (10 μg/kg); epinephrine administration was repeated every 3 min until return of spontaneous circulation (ROSC). The lambs were maintained for 30 min after ROSC. Plasma epinephrine levels were measured before cord clamping, at end asphyxia, and at 3 and 15 min post-ROSC.Results ROSC was successful in 7 of 9 intraosseous epinephrine lambs and in 10 of 12 intravenous epinephrine lambs. The time and number of epinephrine doses required to achieve ROSC were similar between the groups, as were the achieved plasma epinephrine 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 min, but were otherwise similar over the 30 min after ROSC.Conclusions Intraosseous epinephrine administration results in similar outcomes to intravenous epinephrine during resuscitation of asphyxiated newborn lambs. These findings support the inclusion of intraosseous access as a route for epinephrine administration in current guidelines.Data are available upon reasonable request. Data are available to qualified researchers upon reasonable request to the authors.