Abstract 2005: Randomized Controlled Trial of Endotracheal Versus Intravenous Administration of Epinephrine During Neonatal Cardiopulmonary Resuscitation in Asphyxiated Piglets
Concern has been raised regarding the efficacy of 0.01 mg/kg endotracheal (ETT) epinephrine (EPI) for newborns in the delivery room with an inadequate heart rate (HR) (<60 bpm) despite adequate ventilation and chest compressions (CC). New Neonatal Resuscitation Program (NRP) guidelines recommend rapid administration of intravenous (IV) EPI (0.01 to 0.03 mg/kg) for such neonates. NRP suggests that if the ETT route is used while an IV is being established, doses of 0.01–0.03 mg/kg will likely be ineffective and thus administration of a higher ETT EPI dose (up to 0.1 mg/kg) may be considered although the safety and efficacy of this has not been evaluated. Thus, using a randomized, blinded design, we evaluated the efficacy of Standard ETT EPI (0.03 mg/kg) versus a higher dose Experimental ETT EPI (0.07 mg/kg) versus the recommended IV EPI (0.01 mg/kg) during neonatal CPR using an asphyxiated neonatal piglet model of cardiac arrest. Mechanically ventilated, sedated neonatal swine (n=46, age: 7 ± 2 days, weight: 2.3 ± 0.6 kg) were progressively asphyxiated until asystole occurred. Resuscitation followed NRP guidelines: initial ventilation with 100% O2 for 30 sec followed by CC (3 CC:1 ventilation) for 30 sec and subsequent randomized doses of EPI every 3 min for continued asystole. Return of spontaneous circulation (ROSC) was defined as maintenance of spontaneous HR > 60 bpm for > 1 min. Successful ROSC was not different between groups as seen in Table 1⇓. With increasing time after ROSC, less animals remained alive in each group but there were no differences in survival between groups. Although the direction of effect was for ROSC to occur more quickly after intravenous EPI, the difference was not significant. In conclusion, these results suggest that 0.03 mg/kg ETT EPI appears as effective as IV EPI in establishing ROSC for asphyxiated, asystolic piglets and thus might be a reasonable starting dose to use in neonates in the delivery room. Clinical correlation is warranted.