Comparison of Adult and Child Endotracheal Administration of Epinephrine in a Normovolemic Cardiac Arrest Model

Abstract

Background: Maximum concentration (Cmax), Time to maximum concentration (Tmax), Mean Concentration over time (MC), Area under the Curve (AUC), and return of spontaneous circulation (ROSC) were compared between endotracheal epinephrine pediatric (ET Epi Peds) and endotracheal epinephrine adult (ET Epi Adult) groups in a swine cardiac arrest model. Methods: Pigs were placed in arrest for 2 minutes, CPR was initiated for 2 minutes, and epinephrine was then administered. Blood samples were collected over 5 minutes. Epinephrine was repeated every 4 minutes until ROSC. Defibrillation began at 3 minutes and was repeated every 2 minutes until ROSC. Cardiopulmonary + defibrillation (CPR+Defib) and CPR Only groups were control groups. Results: For the ET Pedi Group, the mean ± standard error of mean (SEM) were as follows: Cmax = 204 ± 35 ng/mL; Tmax =142 ± 9 seconds; and AUC = 35,245 ± 7,133 ng/mL. Because only one subject had one measurable epinephrine level in the ET Adult group, we did not compare Cmax, Tmax, or AUC between the groups. The MC of the ET Pedi Group was significantly higher than the ET Adult Group over 5 minutes (p < 05). ROSC frequencies were 8 out of 8 in the ET Pedi Group and 1 out of 7 in the ET Adult Group. Each ET Pedi CPR+Defib and ET Adult CPR+Defib Groups had 1 out of 7 achieve ROSC. None in Pedi CPR Only or Adult CPR Only achieved ROSC. The mean times in seconds ± SD were as follows: ET Pedi Group, 372 ± 163; ET Adult Group, 490 (only 1 subject); ET Pedi CPR+Defib Group, 460 ± 42 (only 1 subject) and ET Adult CPR+Defib 495 (only 1 subject). None in the CPR-Only groups achieved ROSC. Conclusion: The ET route should be considered as a first choice for the administration of epinephrine in a pediatric patient who has a cardiac arrest. We do not recommend using the ET route administration of epinephrine in adults.