Intraosseous Hydroxocobalamin in the Treatment of Acute, Severe Cyanide Induced Cardiotoxicity in a Swine (Sus Scrofa) Model - An Alternate Administration Route for Chemical Mass Casualties

To compare the rerum to baseline of mean arterial blood pressure (MAP) between 2 groups of swine in acute cyanide toxicity and treated with IV HOC or 10 HOC. We also compared blood cyanide, lactate, pH, nitrotyrosine levels, cerebral oxygenation, and inflammatory markers. 24 swine (48-52kg) were intubated, anesthetized, and instrumented (MAP and cardiac output (CO) monitoring). Cyanide was continuously infused until severe hypotension (50 per cent of baseline MAP). Animals were randomly assigned to IV HOC 150mg/kg or 10 HOC 15 0mg/kg and monitored for 60 min after start of antidote. Baseline mean weight, time to hypotension, and cyanide dose at hypotension were similar. At hypotension, mean MAP, blood cyanide, and lactate levels were similar. Both groups had similar return to baseline MAP. Intraosseous hydroxocobalamin led to similar return to baseline of MAP as intravenous. Mortality, heart rate, cardiac output, lactate, nitrotyrosinc, cerebral NTRS , and inflammatory markers were also similar. TO HOC may be as effective as IV HOC in acute, severe cyanide toxicity.
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