title: Comparison of intravenous and endotracheal epinephrine during cardiopulmonary resuscitation in newborn piglets.
abstract: OBJECTIVE
  To compare the efficacy of intravenous and endotracheal epinephrine administration, and intravenous administration above and below the diaphragm, during cardiopulmonary resuscitation in newborn piglets.
  
  
  METHODS
  Prospective, randomized, experimental laboratory protocol.
  
  
  METHODS
  Perinatal cardiovascular research laboratory at a university school of medicine.
  
  
  METHODS
  Forty newborn piglets (Sus domesticus).
  
  
  METHODS
  After cardiac arrest by ventricular fibrillation, cardiopulmonary resuscitation was begun. Radiolabeled epinephrine or placebo (0.9% sodium chloride) was administered into the right atrium, femoral vein, or endotracheal tube. Chest compressions and ventilation were continued for 10 mins.
  
  
  RESULTS
  After epinephrine or placebo administration, samples were obtained from the systemic arterial circulation for measurement of radioisotope activity and plasma epinephrine concentrations. Mean carotid arterial blood pressure, right atrial, and inferior vena caval pressures were measured continuously. Epinephrine administration via the right atrium and femoral vein resulted in significant increases in plasma epinephrine concentration, percent of radioisotope recovery, and mean carotid arterial blood pressure, whereas endotracheal epinephrine administration did not. Placebo administered into the femoral vein resulted in a significant increase in percent radioisotope recovery, but not in plasma epinephrine concentration or carotid arterial blood pressure. Endotracheal administration of placebo did not result in significant increases in plasma epinephrine concentration, percent radioisotope recovery, or carotid arterial blood pressure. There were no significant differences between right atrial or inferior vena caval pressures among the groups.
  
  
  CONCLUSIONS
  During cardiopulmonary resuscitation in newborn piglets, intravenous administration of epinephrine is more efficacious than endotracheal administration. Furthermore, efficacy is similar between femoral venous and right atrial administration.
authors.affiliation: Department of Anesthesia, Children's Hospital, Harvard Medical School, Cambridge, MA, USA.
authors.forename: M E
authors.initials: ME
authors.lastname: Kleinman
authors.forename: W
authors.initials: W
authors.lastname: Oh
authors.forename: B S
authors.initials: BS
authors.lastname: Stonestreet
mesh_terms: D000818:Animals; D000831:Animals, Newborn; D004837:Epinephrine / Q000008:administration & dosage* / Q000097:blood / Q000627:therapeutic use; D006323:Heart Arrest / Q000188:drug therapy*; D006439:Hemodynamics / Q000187:drug effects; D007275:Injections, Intravenous; D007442:Intubation, Intratracheal; D012151:Resuscitation; D013552:Swine; D014662:Vasoconstrictor Agents / Q000008:administration & dosage* / Q000097:blood / Q000627:therapeutic use
chemical_list: D014662:Vasoconstrictor Agents; D004837:Epinephrine