Endotracheal drug administration during out-of-hospital resuscitation: where are the survivors?
BACKGROUND
Drugs administered endotracheally are effectively absorbed during normal spontaneous cardiac activity. However, animal cardiac arrest studies and limited clinical investigations do not support either the use of endotracheal (ET) drugs in doses currently recommended for adults or the method of direct endotracheal instillation. The purpose of this study was to compare the effect of intravenous (IV) and ET drug therapy on outcome from out-of-hospital cardiac arrest secondary to all cardiac arrest rhythms.


METHODS
Five and one-half year retrospective cohort study.


METHODS
Municipal, university affiliated hospital.


METHODS
Consecutive patients >18 years of age in nontraumatic out-of-hospital cardiac arrest who received advanced cardiac life support (ACLS) medications by only the ET or IV route were included.


METHODS
None.


RESULTS
Five hundred and ninety-six patients met inclusion criteria (IV drugs=495, ET drugs=101). There was no difference between groups in the rate of witnessed arrest and the frequency of bystander cardiopulmonary resuscitation (CPR). In the ET drug group, a significantly greater number of patients had an initial documented arrest rhythm of asystole compared to the IV drug group (56 vs 37%, P=0.01). The rate of return of spontaneous circulation (27 vs 15%, P=0.01) and survival to hospital admission rate (20 vs 9%, P=0.01) were significantly greater in the IV drug group. No patient who received ET drugs survived to hospital discharge compared to 5% of those receiving IV drugs (P=0.01).


CONCLUSIONS
For our out-of-hospital advanced rescuer system, ET drugs at recommended doses (twice the IV dose) injected into an ET tube during cardiac arrest and CPR were of no benefit.
Niemann
James T
JT
Department of Emergency Medicine, UCLA School of Medicine, Harbor-UCLA Medical Center, Box 21, 1000 West Carson Street, Torrance, CA 90509, USA. jniemann@emedharbor.edu
Stratton
Samuel J
SJ
Cruz
Brian
B
Lewis
Roger J
RJ
D000322:Adrenergic Agonists / Q000008:administration & dosage* / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D001285:Atropine / Q000008:administration & dosage / Q000627:therapeutic use; D015331:Cohort Studies; D004632:Emergency Medical Services; D004837:Epinephrine / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D006323:Heart Arrest / Q000188:drug therapy*; D006801:Humans; D007262:Infusions, Intravenous; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D012151:Resuscitation; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
D000322:Adrenergic Agonists; D001285:Atropine; D004837:Epinephrine