Central versus peripheral intravenous routes in cardiopulmonary resuscitation

The central venous (CV) and peripheral venous (PV) routes of drug administration are generally considered to be equally effective during cardiopulmonary resuscitation (CPR). This canine study compared simulated drug delivery via CV and PV routes during CPR. The CV group dogs had a CV catheter placed via the external jugular vein, and the PV group dogs had a PV catheter placed in the distal forelimb. Thirty seconds after the induction of cardiac arrest with KCl, CPR was begun with a gas-powered chest compressor with ventilations after every fifth compression. Sixty seconds later, a 0.5 ml bolus of technetium 99m-labeled serum albumin was given. Time activity curves were obtained over the right and left ventricles. The mean time for the counts to rise to half the left ventricular peak (T1/2LV) was significantly less for the CV group than for the PV group (P less than 0.05), averaging 11 and 84 seconds, respectively. The time to left ventricular peak (TLV) was also statistically shorter for the CV group than the PV group, averaging 118 versus 258 seconds, respectively. This study demonstrates that central venous administration is more rapid than peripheral venous administration during CPR and supports the preferential use of the central venous route for drug administration clinically.