Endotracheal versus intravenous epinephrine during electromechanical dissociation with CPR in dogs

doi:10.1016/S0196-0644(85)80916-1

Annals of Emergency Medicine

Volume 14, Issue 11, November 1985, Pages 1044-1048

https://doi.org/10.1016/S0196-0644(85)80916-1 Get rights and content

The dose-response curves of epinephrine given either IV or endotracheally (ET) were compared during resuscitation from electromechanical dissociation (EMD). Ten anesthetized dogs were subjected to a two-minute period of electrically induced ventricular fibrillation (VF) followed by defribrillation without CPR to produce EMD. Mechanical CPR was followed by injection of either ET or IV epinephrine. Successful response was defined as a return of pulsatile blood pressure within two minutes of drug administration. Using log-dose increments of epinephrine, experimental trials were repeated in each animal. The IV and ET median effective doses were 14 and 130 μg/kg, respectively. When the trials were successful, the time between drug administration and either arterial blood pressure increases or return of spontaneous circulation did not differ significantly for the ET and IV groups. These results show that the dosage for epinephrine delivered ET must be higher than the IV dosage to achieve the same response during CPR.

References (20)

RalstonSH et al.
Intrapulmonary epinephrine during cardiopulmonary resuscitation: Improved regional blood flow and resuscitation in dogs
Ann Emerg Med
(1984)
RobertsJR et al.
Blood levels following intravenous and endotracheal epinephrine administration
JACEP
(1979)
RobertsJR et al.
Comparison of the pharmacological effects of epinephrine administered by the intravenous and endotracheal routes
JACEP
(1978)
ThijsLG et al.
A closed-chest model for the study of electromechanical dissociation
Resuscitation
(1982)
EwyGA
Defining electromechanical dissociation
Ann Emerg Med
(1984)
GreenbergMI et al.
Comparison of deep and shallow endotracheal administration of dionosil in dogs and effect of manual hyperventilation
Ann Emerg Med
(1985)
KosnikJW et al.
Dose-related response of centrally administered epinephrine on the change in aortic diastolic pressure during closed-chest massage in dogs
Ann Emerg Med
(1985)
CrileG et al.
Experimental research into resuscitation of dogs killed by anesthetics and asphyxia
J Exp Med
(1906)
ReddingJS et al.
Resuscitation from asphyxia
JAMA
(1962)
PearsonJW et al.
The role of epinephrine in cardiac resuscitation
Anesth Analg
(1963)

There are more references available in the full text version of this article.

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: Presented at the University Association for Emergency Medicine Annual Meeting in Kansas City, Missouri, May 1985.

: This study was supported in part by Grant HL-29398 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland.

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Original contributionEndotracheal versus intravenous epinephrine during electromechanical dissociation with CPR in dogs

Ann Emerg Med

JACEP

JACEP

Resuscitation

Ann Emerg Med

Ann Emerg Med

Ann Emerg Med

Experimental research into resuscitation of dogs killed by anesthetics and asphyxia

J Exp Med

Resuscitation from asphyxia

JAMA

The role of epinephrine in cardiac resuscitation

Anesth Analg

Original contribution
Endotracheal versus intravenous epinephrine during electromechanical dissociation with CPR in dogs