Absorption and Hemodynamic Effects of Airway Administration of Adrenaline in Patients with Severe Cardiac Disease

If intravenous access cannot be attained during resuscitation of adult patients, endotracheal application of at least 2 mg of adrenaline is recommended. However, the effects of this intervention have not yet been demonstrated in adults.To demonstrate the effects of adrenaline administered through the airways.Prospective clinical trial.Operating theater at university hospital.34 patients receiving implantable cardioverter defibrillators under general anesthesia.When mean arterial pressure decreased below 80 mm Hg, 100 times the effective central intravenous dose of adrenaline (mean +/- SD, 1.3+/-0.6 mg [range, 0.7 to 3 mg]) was administered over 5 seconds into the endotracheal tube or through a bronchial catheter. Ten forced ventilations followed.Hemodynamic variables were recorded with a polygraph recorder. Adrenaline levels were measured in 13 patients.Plasma levels and arterial pressure increased in all patients (P < 0.002). Higher plasma levels (P < 0.039) and greater arterial pressure (P < 0.001) were achieved with this method than with intravenous injection. The effects of adrenaline did not differ between the two airway routes. Sustained ventricular arrhythmia did not occur.These substantial effects support the standard recommendation to consider the airways as an alternate route for at least 2 mg of adrenaline during resuscitation.