Background: If intravenous access cannot be attained during resuscitation of adult patients, endotracheal application of at least 2 mg of adrenaline is recommended. However, the effects of this intervention have not yet been demonstrated in adults.
Objective: To demonstrate the effects of adrenaline administered through the airways.
Design: Prospective clinical trial.
Setting: Operating theater at university hospital.
Patients: 34 patients receiving implantable cardioverter defibrillators under general anesthesia.
Intervention: When mean arterial pressure decreased below 80 mm Hg, 100 times the effective central intravenous dose of adrenaline (mean Â± SD, 1.3 Â± 0.6 mg [range, 0.7 to 3 mg]) was administered over 5 seconds into the endotracheal tube or through a bronchial catheter. Ten forced ventilations followed.
Measurements: Hemodynamic variables were recorded with a polygraph recorder. Adrenaline levels were measured in 13 patients.
Results: Plasma levels and arterial pressure increased in all patients (P <Â 0.002). Higher plasma levels (P Â <Â 0.039) and greater arterial pressure (P Â <Â 0.001) were achieved with this method than with intravenous injection. The effects of adrenaline did not differ between the two airway routes. Sustained ventricular arrhythmia did not occur.
Conclusion: These substantial effects support the standard recommendation to consider the airways as an alternate route for at least 2 mg of adrenaline during resuscitation.