Intraosseous Medication Administration

Current recommendations for intraosseous (IO) medication administration are largely based upon preclinical animal studies and anecdotal reports of IO medication infusion for patients in emergent situations due to cardiac arrest, hemodynamic instability, respiratory failure, acute pain, poisoning, and neurological emergencies. Although a wide variety of medications have been infused via the IO route, little evidence exists to confirm the general assumption that IO infusion is equivalent to intravenous infusion of emergent medications. This chapter explores current evidence on the IO infusion of various medications and offers insight into how the unique physiologic characteristics of the IO space may prompt the need for consideration of route of infusion when prescribing the dose and timing of various IO medications. Controversies regarding outcomes for patients receiving medication via the IO route, as compared to the direct venous routes, are described. Future directions needed for preclinical and clinical research are also explored.