Administration of Norepinephrine Through Humeral Head IO

IO Access for Medication Administration

IO access is a valid alternative when IV access is not readily available during resuscitation, and all ACLS medications can be administered through this route, as recommended by the American Heart Association 1.
When establishing vascular access during cardiac arrest, the primary purpose is to provide drug therapy, and this should be performed without interrupting chest compressions, according to the American Heart Association 1.

Norepinephrine is indicated for treatment of severe hypotension (e.g., systolic blood pressure <70 mmHg) and low total peripheral resistance, with a typical starting dose of 0.1-0.5 mcg/kg/min, as recommended by the American Heart Association 2.
The American Heart Association recommends that vasopressors like norepinephrine be used only when the combination of an inotropic agent and fluid challenge fails to restore adequate blood pressure and organ perfusion, with a strength of evidence level of IIa 3.
The European Society of Cardiology recommends that norepinephrine be used to treat severe hypotension and low total peripheral resistance, with careful monitoring of blood pressure and organ perfusion 2.

Extravasation of norepinephrine can cause tissue necrosis, so proper IO needle placement confirmation is essential, as warned by the American Heart Association 2.
If extravasation occurs, infiltrate 5-10 mg of phentolamine diluted in 10-15 mL of saline into the site as soon as possible to prevent tissue damage, as recommended by the American Heart Association 2.