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Endotracheal versus Intravenous Epinephrine in the Prehospital Treatment of Cardiac Arrest

Published online by Cambridge University Press:  28 June 2012

Sandra M. Schneider ,
Donald M. Yealy ,
Edward A. Michaelson ,
Thomas R. Kearns  and
Paul M. Paris
Sandra M. Schneider*
Affiliation:
The Division of Emergency Medicine, University of Pittsburgh, PA, USA The Center for Emergency Medicine of Western Pennsylvania, Pittsburgh, PA., USA The Division of Medical Emergency Services, Montefiore Hospital of Pittsburgh, USA
Donald M. Yealy
Affiliation:
The Division of Emergency Medicine, University of Pittsburgh, PA, USA The Center for Emergency Medicine of Western Pennsylvania, Pittsburgh, PA., USA The Darnall Army Community Hospital, Fort Hood, TX., USA
Edward A. Michaelson
Affiliation:
The Division of Emergency Medicine, University of Pittsburgh, PA, USA The Center for Emergency Medicine of Western Pennsylvania, Pittsburgh, PA., USA The Division of Medical Emergency Services, Montefiore Hospital of Pittsburgh, USA
Thomas R. Kearns
Affiliation:
The Division of Emergency Medicine, University of Pittsburgh, PA, USA The Center for Emergency Medicine of Western Pennsylvania, Pittsburgh, PA., USA
Paul M. Paris
Affiliation:
The Division of Emergency Medicine, University of Pittsburgh, PA, USA The Center for Emergency Medicine of Western Pennsylvania, Pittsburgh, PA., USA Department of Public Safety, Bureau of Emergency Medical Services, City of Pittsburgh, PA, USA
*
Sandra M. Schneider, MD, EMS, Montefiore Hospital, 3459 Fifth Avenue, Pittsburgh, PA, USA 15213
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Abstract

We performed a retrospective review of the charts of 252 adult, non-traumatic, prehospital cardiac arrest patients treated over a one-year period in order to assess the effectiveness of intravenous (IV) and endotracheal (ET) administration of epinephrine (0.5–1.0 mg) (EPI) in assisting restoration of a spontaneous pulse. Patients initially receiving IV-EPI were more likely to develop a spontaneous pulse earlier than those receiving a similar dose ET (7.3% vs 0.9%; p<0.01. In those patients who received a second dose of EPI, six (2.9%) regained a spontaneous pulse; each had been treated previously with IV-EPI. None who required a third dose of EPI regained a spontaneous pulse. In total, only five (2%) patients survived to discharge. We conclude that, in our system, patients who receive the currently recommended dose of EPI to treat cardiac arrest have a poor prognosis, and that IV-EPI is associated with a higher incidence of return of a spontaneous pulse compared to those treated ET.

Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 5 , Issue 4 , December 1990 , pp. 341 - 348
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1990

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References

1. Standards and guidelines for cardiopulmonary resuscitation and emergency cardiac care. JAMA 1986;255:1905–1989.Google Scholar
2. Raehl, CL: Endotracheal drug therapy in cardiopulmonary resuscitation. Clin Pharmacy 1986;5:572–579.Google Scholar
3. Brown, DH, Kasuya, A, Leiken, JB: Endotracheal drug administration in the critical care setting. J Emerg Med 1987;5:407–414.Google Scholar
4. Greenberg, MI: The use of endotracheal medication in cardiac emergencies. Resuscitation 1984;12:155–165.CrossRefGoogle ScholarPubMed
5. Powers, RD, Donowitz, LG: Endotracheal administration of emergency medications. South Med J 1984;77:340–346.CrossRefGoogle ScholarPubMed
6. Lindemann, R: Endotracheal administration of epinephrine during cardiopulmonary resuscitation. Am J Dis Child 1982;136:753 (Abstract).Google Scholar
7. Polin, K, Brown, DH, Leiken, JB: Endotracheal administration of epinephrine and atropine. Ped Emerg Care 1986;2:168–169.CrossRefGoogle ScholarPubMed
8. Roberts, JR, Greenberg, MI, Baskin, SI: Endotracheal epinephrine in cardiopulmonary collapse. JACEP 1979;8:515.CrossRefGoogle Scholar
9. Quinton, DN, O'Byrne, G, Aitkenhead, AR: Comparison of endotracheal and peripheral intravenous adrenaline in cardiac arrest. Lancet 1987;53:828–829.CrossRefGoogle Scholar
10. Cobb, LA, Werner, JA, Trobaugh, GB: Sudden cardiac death: A decade's experience with out-of-hospital resuscitation. Mod Concepts Cardiovasc Dis 1980;49:31–36.Google ScholarPubMed
11. Weaver, WD, Cobb, LA, Hallstrom, AP, et al. Factors influencing survival after out-of-hospital cardiac arrest. J Am Coll Cardiol 1986;7:752–757.Google Scholar
12. Roth, R, Stewart, RD, Rogers, K, et al. Out-of-hospital cardiac arrest: Factors associated with survival. Ann Emerg Med 1984;13:237–243.Google Scholar
13. Eisenberg, MS, Horwood, BT, Cummins, RO, et al. Cardiac arrest and resuscitation: A tale of 29 cities. Ann Emerg Med 1990;19:179–186.CrossRefGoogle ScholarPubMed
14. Elam, J: The intrapulmonary route for CPR drugs. In Safar, P (ed): Advances in Cardiopulmonary Resuscitation. New York, Springer-Verlag, 1977, pp 132–140.Google Scholar
15. Roberts, JR, Greenberg, MI, Knaub, M, Baskin, SI: Comparison of the pharmacological effects of epinephrine administered by the intravenous and endotracheal routes. JACEP 1978;7:260–264.CrossRefGoogle ScholarPubMed
16. Roberts, JR, Greenberg, MI, Knaub, MA, et al. Blood levels following intravenous and endotracheal epinephrine administration. JACEP 1979;8:53–56.Google Scholar
17. Greenberg, MI, Roberts, JR, Krusz, JC, Baskin, SI: Endotracheal epinephrine in a canine anaphylactic shock model. JACEP 1979;8:500–503.CrossRefGoogle Scholar
18. Chernow, B, Holbrook, P, D'Angona, DS, et al. Epinephrine absorption after intratracheal administration. Anesth Analg 1984;63:829–832.CrossRefGoogle ScholarPubMed
19. Klain, M, Kezlar, H, Nordin, U, Kalla, R: Intrapulmonary drug administration during high frequency jet ventilation. Prehospital Disaster Med 1985;1:220–222.CrossRefGoogle Scholar
20. Greenberg, MI, Spivey, WH: A comparison of deep versus shallow endotracheal administration of dionosil in dogs and the effect of manual hyperventilation. Ann Emerg Med 1985;14:209–212.Google Scholar
21. Brown, CG, Werman, HA, Davis, EA, et al. The comparative effect of graded doses of epinephrine on regional cerebral blood flow in a swine model. Ann Emerg Med 1986;15:1138–1144.CrossRefGoogle Scholar
22. Brown, CG, Taylor, RB, Werman, HA, et al. Myocardial oxygen delivery and consumption during CPR: A comparison of epinephrine and phenylephrine. Ann Emerg Med 1988;17:302–308.Google Scholar
23. Koscove, EM, Paradis, NA: Successful resuscitation from cardiac arrest using high dose epinephrine therapy: Report of two cases. JAMA 1988;259:3031–3034.Google Scholar
24. Martin, D, Werman, HA, Brown, CG: Four case studies: High dose epinephrine in cardiac arrest. AnnEmerg Med 1990;19:322–326.Google Scholar
25. Ralston, SH, Tacker, WA, Showen, L, et al. Endotracheal versus intravenous epinephrine during electromechanical dissociation with CPR in dogs. Ann Emerg Med 1985;14:1044–1048.CrossRefGoogle ScholarPubMed