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Does endotracheal administration of adrenaline (epinephrine) work?
- Naresh Ramakrishnan1
© Current Science Ltd 2000
- Published: 15 June 2000
- endotracheal administration
To assess the efficacy of endotracheal administration of adrenaline (epinephrine) in humans.
Prospective randomized trial involving 34 anesthetized patients (5 women, 29 men) receiving an implantable cardio-verter defibrillator.
After intubation, when mean arterial pressure (MAP) fell below 80 mmHg (after adequate fluid loading), IV adrenaline was injected via central line, at a dose of 1 µg/kg, with dose escalation to achieve the required MAP.
Once the IV dose was established, the next time they were hypotensive, 100 times the IV dose was administered diluted in 10 ml of saline and administered slowly over 5 seconds into the airways, followed by 10 forced ventilations.
There were two subgroups: one group received adrenaline directly into the ET (n = 17), and the other received adrenaline via a bronchial catheter wedged into a bronchus (laced under radiological guidance) (n = 17).
The patients' clinical characteristics apparently did not differ between groups (data not shown).
Mean dose of adrenaline ± SD = 1.3 ± 0.6 mg (range, 0.7 to 3 µg)
Plasma catecholamine samples were collected from the second lumen of the central intravenous line immediately before adrenaline administration; 0.5, 2, 3, and 5 min after IV administration; and 0.5, 2, 3, 5, 10, and 20 min after ET administration.
Airway administration of adrenaline significantly increased plasma adrenaline levels more than 200-fold, from 0.26 ± 0.21 nmol/l (range, 0.05 to 0.71 nmol/l) to 57.9 ± 56.8 nmol/l (range, 8.2 to 205.8 nmol/l) (P = 0.0015). MAP increased by almost 100% (P < 0.001), and heart rate increased from 64.0 ± 12.6 beats/min (range, 40 to 100 beats/min) to a maximum of 79.7 ± 20.5 beats/min (range, 50-140 beats/min). A delayed response was seen when adrenaline was administered through the airways. Mean time to first response in MAP of >10 mmHg, via the IV route, was 25.1 ± 15.1 seconds (SD 3.6-79.2) and via the ET route 64.0 ± 68.5 seconds (SD 8.4-279.6), P < 0.001. Mean time to reach the peak effect on MAP in seconds via IV route was 82.3 ± 31.0 (SD 11-131) and via the ET route was 219.8 ± 136.2 (SD 62-528), P < 0.001. There was no statistical difference between the two airway subgroups. ET administration of adrenaline appears as effective as IV; however, a time lag was seen and peripheral bronchial administration of adrenaline through a catheter (which is cumbersome and time-consuming) seems unnecessary.
The universal advanced life support algorithm: an advisory statement from the Advanced Life Support Working Group of the International Liaison Committee on Resuscitation. (Kloeck W et al, Circulation 1997, 95:2180-2182)
Endotracheal versus intravenous epinephrine during electromechanical dissociation with CPR in dogs. (Ralston et al, Ann Emerg Med 1985, 14:1044-1048).
Comparison of endotracheal and peripheral intravenous adrenaline in cardiac arrest. Is the endotracheal route reliable? (Quinton et al, Lancet 1987, 1:828-829.
Haemodynamic effects of tracheal compared with intravenous adrenaline (McCrirrick et al, Lancet 1992, 340:868-870.
Comparison of i.v. and intra-tracheal administration of adrenaline (McCrirrick et al, Br J Anaesth 1994, 72:529-532)