Intracardiac injections are injections that are given directly into the heart muscles or ventricles. They can be used in emergencies, although they are rarely used in modern practice.

History

The practice of intracardiac injection originated in the 1800s. It was commonly performed during the 1960s, as it was considered the fastest way to get medication to the heart. The practice began declining during the 1970s as more reliable delivery methods (i.e.,

intravenous Intravenous therapy (abbreviated as IV therapy) is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutrie ...

, endotracheal, and intraosseous) came into use. Around that time, studies revealed that intravenous injections were equally effective and were less prone to risks and complications.

Procedure

Intracardiac injections of drugs were generally used only to provide emergency drugs to a patient if other approaches would be ineffective; for example if drugs could not be administered

intravenously Intravenous therapy (abbreviated as IV therapy) is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutrie ...

due to individual circumstances. The procedure is performed by inserting a long

spinal needle Spinal anaesthesia (or spinal anesthesia), also called spinal block, subarachnoid block, intradural block and intrathecal block, is a form of neuraxial regional anaesthesia involving the injection of a local anaesthetic or opioid into the subara ...

into the ventricular chamber. The needle is inserted in the fourth intercostal space between the ribs. Today it is considered obsolete, and other routes to give drugs are preferred (i.e. via an endotracheal tube or intraosseous (direct in the bone))

Complications

The two primary complications are injury to the

coronary artery The coronary arteries are the arterial blood vessels of coronary circulation, which transport oxygenated blood to the heart muscle. The heart requires a continuous supply of oxygen to function and survive, much like any other tissue or organ o ...

and

hemorrhage Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, v ...

within the

pericardium The pericardium, also called pericardial sac, is a double-walled sac containing the heart and the roots of the great vessels. It has two layers, an outer layer made of strong connective tissue (fibrous pericardium), and an inner layer made ...

. Bloods fills this external covering or “sac” of the heart, called pericardium, causing external pressure on the heart, which prevents it from filling. The probability of complications can be reduced by using a narrow

gauge Gauge ( or ) may refer to: Measurement * Gauge (instrument), any of a variety of measuring instruments * Gauge (firearms) * Wire gauge, a measure of the size of a wire ** American wire gauge, a common measure of nonferrous wire diameter, es ...

of needle. Use of intracardiac injections requires the cessation of

cardiopulmonary resuscitation Cardiopulmonary resuscitation (CPR) is an emergency procedure consisting of chest compressions often combined with artificial ventilation in an effort to manually preserve intact brain function until further measures are taken to restore spont ...

and may be more time-consuming than other delivery methods.

Society and culture

In the movie ''

Pulp Fiction ''Pulp Fiction'' is a 1994 American crime film written and directed by Quentin Tarantino, who conceived it with Roger Avary.See, e.g., King (2002), pp. 185–7; ; Starring John Travolta, Samuel L. Jackson, Bruce Willis, Tim Roth, Vin ...

'', an intracardiac injection of

epinephrine Adrenaline, also known as epinephrine, is a hormone and medication which is involved in regulating visceral functions (e.g., respiration). It appears as a white microcrystalline granule. Adrenaline is normally produced by the adrenal glands and ...

is used to treat a heroin overdose (far from the normal medical treatment for this condition, an intravenous or intramuscular injection of

naloxone Naloxone, sold under the brand names Narcan (4 mg) and Kloxxado (8 mg) among others, is a medication used to reverse or reduce the effects of opioids. It is commonly used to counter decreased breathing in opioid overdose. Effects begin withi ...

). In the movie '' The Rock'', a character self-administers intracardiac

atropine Atropine is a tropane alkaloid and anticholinergic medication used to treat certain types of nerve agent and pesticide poisonings as well as some types of slow heart rate, and to decrease saliva production during surgery. It is typically given ...

to counter the effects of VX nerve gas after exposure.

References

{{Dosage forms, state=expanded Dosage forms