Elsevier

Resuscitation

Volume 36, Issue 3, March 1998, Pages 187-192
Resuscitation

Plasma catecholamine levels following tracheal and intravenous epinephrine administration in swine

https://doi.org/10.1016/S0300-9572(98)00007-0Get rights and content

Abstract

We compared plasma epinephrine levels after three different tracheal epinephrine application techniques and intravenous injection in male and female anesthetized and paralyzed domestic pigs. Epinephrine was administered intravenously (10 μg/kg) (group IV) or tracheally (100 μg/kg) either by direct injection into the upper end of the tracheal tube (group Tube), via a suction tube placed into the bronchial system (group Catheter) or using an EDGAR tube (group EDGAR), each group: n=8. Arterial plasma samples were drawn before and 0.5, 1, 1.5, 2, 2.5, 3, 4, 5, 6, 7 and 10 min after epinephrine administration. Plasma concentrations of epinephrine were measured with high pressure liquid chromatography using electrochemical detection. Analysis was performed by regression analysis for correlated data. Total plasma epinephrine concentrations showed a significant increase within 0.5 min in all groups. However, peak plasma epinephrine levels in group IV were significantly higher than in tracheal groups, while no differences between tracheal groups over the time were found. We conclude that in swine with spontaneous circulation tracheal instillation techniques using special devices such as suction tubes or EDGAR tubes result in onset and peak plasma epinephrine levels equivalent to those after direct injection into the upper end of the tracheal tube.

Introduction

Several case reports and studies have shown that effective systemic levels of epinephrine are reached by tracheal (t) administration 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15. The American Heart Association (AHA) has approved this application route in its recommendations for CPR and other life-threatening conditions in cases where there are difficulties in starting a safe intravenous line in time [16]. Several different e.t. administration techniques have been described 7, 8, 9, 11, 13, 14, 15. However, diversity of the CPR models and administration methods make it difficult to compare the effectiveness of the various methods. Therefore, the optimal e.t. delivery technique is still unknown [17]. So far, the AHA recommends to give the drugs via a catheter whose tip is placed beyond the end of the tracheal tube [16]. However, in a pediatric porcine hypoxic-hypercarbic cardiopulmonary arrest model Jasani et al did not find a difference between different e.t. administration techniques [17]. We compared the efficacy of three e.t. administration techniques and the intravenous administration on epinephrine plasma levels in an adult non-arrest porcine model. We hypothesized that plasma levels of e.t. administered epinephrine would not be different between three standardized instillation techniques and would be equivalent to plasma epinephrine levels after intravenous injection.

Section snippets

Materials and methods

The study was approved by the Governmental Review Board for the care of animal subjects. Care and handling of animals were in accordance with national and institutional regulations. Male and female conditioned domestic pigs were randomised into four groups: group IV: administration of epinephrine via a peripheral vein, and three different e.t. groups: group Tube: injection of epinephrine into the upper end of a regular tracheal tube, group Catheter: injection of epinephrine in a suction tube

Results

There were no differences between groups concerning biometric data (Table 1). Twenty-nine animals could be included for data analysis. In group Catheter arterial blood samples for one animal could not be taken on time due to catheter occlusion, in group IV one animal received the wrong drug dose, and in one animal the intravenous injection infiltrated. Norepinephrine levels remained constant throughout with no differences between groups (Fig. 1). Within 0.5 min after dosing a significant

Discussion

In CPR situations, most patients are intubated to protect the airway, to provide controlled ventilation and to optimize oxygen delivery [16]. As an additional benefit intubation offers an alternative route for administering life-saving drugs. This route, which is often more easily secured than a vascular access, leads to an extremely large absorptive area—the bronchoalveolar region. Though venous administration is recommended in the AHA guidelines, it is sometimes difficult to install a safe

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