{
  "abstract": "Background Medication stability is assured when stored and used per manufacturer specifications (usually room temperature), but the impact of storage in extreme temperature environments is largely unknown. Artic and Polar missions will expose medications to deep freezing and frequent freeze-thaw cycling unless rigorous temperature mitigation strategies are used. For this series of benchtop experiments, we hypothesize that sterile injectable medications, commonly used during point of injury and en route care, will have variable physical and chemical tolerances to exposure of up to 90 days of deep freezing or freeze-thaw cycling. This abstract includes and builds upon our previous work.1 Methods With military stakeholder input, twenty essential medications were placed in programmed environmental chambers to maintain a deep freeze (-51°C) or to freeze-thaw cycle every 12 hours (-40°C to 20°C) mimicking possible operational scenarios. Controls were stored per manufacturer recommendations. Six vials of each medication were placed in each environment for 30, 60, and 90 days of exposure. All vials were from the same manufacturer’s lot, except dextrose due to ongoing national shortages. After exposure, each vial was examined for physical/visual abnormalities and unbroken vials were sent to a commercial lab for concentration testing via high performance liquid chromatography. Changes from labelled concentration >10% were considered significant, consistent with US Food and Drug Administration guidance.Results Amiodarone, dexamethasone, diphenhydramine, haloperidol, ketorolac, metoprolol, norepinephrine, ondansetron, phenylephrine, promethazine, and rocuronium show physical and pharmacostability through 90 days in both environments. Propofol shows disruption of the emulsion and significant degradation after 30 days in both environments. Calcium chloride, sodium bicarbonate, succinylcholine, and tranexamic acid vials frequently shattered by 30 days of exposure. One naloxone vial experienced chemical degradation >10% of labelled concentration. At 30 days, all epinephrine vials had physical change with separation of protective caps from the vials, and two had breakage; unbroken vials showed no degradation in either environment. Atropine experienced limited breakage and no degradation. Several dextrose vials shattered at some point after removal from the environmental chambers and before testing, including some from the room temperature control group; tested vials showed no degradation.Conclusion Some critical medications experience physical failure and/or chemical degradation when exposed to up to 90 days of deep freeze or freeze-thaw cycles. Studied formulations of calcium chloride, epinephrine, propofol, sodium bicarbonate, succinylcholine, and tranexamic acid should not be deployed unless these temperature extremes can be avoided; the durability of dextrose vials is uncertain. Alternative formulations, packaging, and environmental mitigation solutions should be considered.Abstract A25 Figure 1Observed physical and pharmacostability of twenty essential medications exposed to up to 90 days of cold and ultra-cold temperaturesReferences McMullan J, Droege C, Blakeman T, Fowler JM, Mueller E, Smith M, Foertsch M. Physical and pharmacostability of 15 essential medications in cold and ultracold environments. J Trauma Acute Care Surg. 2025 Jun 4. doi: 10.1097/TA.0000000000004648. Epub ahead of print. PMID: 40462279.",
  "authors": [
    {
      "affiliations": [
        "Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH"
      ],
      "name": "Jason McMullan"
    },
    {
      "affiliations": [
        "Department of Pharmacy Services, UC Health, University of Cincinnati Medical Center, Cincinnati, OH; Division of Pharmacy Practice and Administration, University of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, OH"
      ],
      "name": "Christopher Droege"
    },
    {
      "affiliations": [
        "Department of Surgery, Div of General Surgery, University of Cincinnati College of Medicine, Cincinnati, OH"
      ],
      "name": "Thomas C Blakeman"
    },
    {
      "affiliations": [
        "Cape Fox Federal Integrators, Chantilly, VA"
      ],
      "name": "John-Michael Fowler"
    },
    {
      "affiliations": [
        "Department of Surgery, Div of General Surgery, University of Cincinnati College of Medicine, Cincinnati, OH"
      ],
      "name": "Eric Mueller"
    },
    {
      "affiliations": [
        "Cape Fox Federal Integrators, Chantilly, VA"
      ],
      "name": "Maia Smith"
    },
    {
      "affiliations": [
        "Department of Pharmacy Services, UC Health, University of Cincinnati Medical Center, Cincinnati, OH; Division of Pharmacy Practice and Administration, University of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, OH"
      ],
      "name": "Madeline Foertsch"
    }
  ],
  "title": "A25 Physical and pharmacostability of twenty essential medications in cold and ultra-cold environments",
  "uid": "089c3577-7dfb-5b11-89e6-4735a36fb4d5"
}