Effect of dose on the nasal absorption of epinephrine during cardiopulmonary resuscitation

Bleske, Barry E.; Rice, Ted L.; Warren, Eric W.; Giacherio, Donald; Gilligan, Lori J.; Massey, Kenneth; Tait, Alan R.

doi:10.1016/s0735-6757(96)90119-9

Cited by 15 publications

(4 citation statements)

References 7 publications

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“…Nevertheless, 50% of severely asphyxiated lambs achieved ROSC following 2 doses of Nasal-Adr, and as such if concentrations were measured between 6 and 9 mins after CCs, it is possible that adrenaline levels would have been elevated. Nasal adrenaline administration has been evaluated in other acute post-neonatal animal models (25)(26)(27)(28), but to our knowledge never in a transitional newborn asphyxia model. In our study, nasal adrenaline administration was simple and fast, and the cardiovascular response in Nasal-Adr lambs was similar to ET-Adr.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Intravenous, Endotracheal, or Nasal Adrenaline Administration During Resuscitation of Near-Term Asphyxiated Lambs

et al. 2020

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Objectives: Neonatal resuscitation guidelines recommend administering intravenous (IV) adrenaline if bradycardia persists despite adequate ventilation and chest compressions (CC). Rapid IV access is challenging, but little evidence exists for other routes of administration. We compared IV, endotracheal (ET), and intranasal routes for adrenaline administration during resuscitation of asphyxiated newborn lambs. Study design: Near-term lambs (n = 22) were delivered by caesarean section. Severe asphyxia was induced by clamping the umbilical cord while delaying ET ventilation until blood flow in the carotid artery ceased. Following a 30 s sustained inflation and ventilation for 30 s, we commenced uncoordinated CC at 90/min. We randomized four groups receiving repeated treatment doses (Tds) every 3rd min of (i) IV-Adrenaline (50 µg), (ii) ET-Adrenaline (500 µg), (iii) Nasal-Adrenaline via an atomizer (500 µg), and (iv) IV-saline. If return of spontaneous circulation (ROSC) was not achieved after three Tds by the assigned route, up to two rescue doses (Rds) of IV adrenaline were administered. Main outcome measures were achievement of ROSC and time from start of CC to ROSC, defined as heart rate >100/min, and mean carotid arterial pressure >30 mmHg. Results: In the IV-Adrenaline group, 5/6 lambs achieved ROSC after the first Td, whereas 1 lamb required two Tds before achieving ROSC. In the ET-Adrenaline group, 1/5 lambs required one Td, 1 lamb required three Tds, 2 lambs required 2 Rds, and 1 did not achieve ROSC. In the Nasal-Adrenaline group, 1/6 lambs required one Td, 2 required two Tds, whereas 3 lambs required either one (2 lambs) or two (1 lamb) Rds of adrenaline to achieve ROSC. In the IV-saline group, no lambs achieved ROSC until adrenaline Rds; 4/5 lambs required one Rd and 1 lamb required two Rds. Time to ROSC was shorter using IV-Adrenaline (2.4 ± 0.4 min) compared with ET-Adrenaline (10.3 ± 2.4 min), Nasal-Adrenaline (9.2 ± 2.2 min), and IV-saline (11.2 ± 1.2 min). Songstad et al. Nasal Adrenaline During Newborn Resuscitation Conclusion: IV adrenaline had superior efficacy compared with nasal or ET administration. Nasal administration had a similar effect as ET administration and is an easier route for early application. Nasal high-dose adrenaline administration for neonatal resuscitation merits further investigation.

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Section: Discussionmentioning

confidence: 99%

Efficacy of Intravenous, Endotracheal, or Nasal Adrenaline Administration During Resuscitation of Near-Term Asphyxiated Lambs

et al. 2020

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“…Canine studies have been performed where epinephrine has been applied intranasally and shown to exhibit similar systemic effects to intravenous epinephrine. 10,11 Animal models are one potential method for studying the toxic dose of intranasal 1:1000 topical epinephrine. Some potential limitations of the current study deserve mention.…”

Section: Discussionmentioning

confidence: 99%

Approximate Weight of 1:1000 Topical Epinephrine on Wrung‐Out Epinephrine‐Soaked Pledgets

Kuhar

Han

Penning

et al. 2019

Otolaryngol.--head neck surg.

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Objective Topical 1:1000 epinephrine solution is commonly applied intranasally with cottonoid pledgets in endoscopic sinonasal surgery for local vasoconstriction and hemostasis. Pledgets are typically submerged in epinephrine solution and applied without measurement. Hemodynamic complications have been reported when pledgets have been saturated and not wrung out. The amount of epinephrine absorbed per pledget has not been studied methodically. The purpose of this study was to determine the amount of topical 1:1000 epinephrine remaining on a cottonoid pledget after wringing out the pledget, to simulate intraoperative application. Study Design Cohort study. Setting Tertiary care center. Subjects and Methods Sixty 0.5-in × 3-in cottonoid pledgets were submerged in canisters filled with 1:1000 epinephrine solution (1 mg/mL). Weights of the epinephrine-filled canisters were measured before submerging the pledgets and then after removing and wringing out the pledgets. Measurements were recorded for each pledget after being submerged for 0, 1, and 5 minutes and then wrung out. Mean weights were calculated and compared between the submersion durations. Results The mean overall weight of epinephrine on a wrung-out pledget was 0.931 mg. Mean weights of epinephrine absorbed onto wrung-out pledgets after submersion for 0, 1, and 5 minutes were 0.914, 0.913, and 0.967 mg, respectively. There were no significant differences in weights based on submersion duration ( P = .296). Conclusion Approximately 1 mg of epinephrine was absorbed onto 0.5-in × 3-in cottonoid pledgets when pledgets were wrung out after being submerged in 1:1000 epinephrine, whether being removed from solution immediately or after up to 5 minutes.

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“…Nasal epinephrine is currently not recommended during neonatal resuscitation, and limited data are available. A study using an adult canine model reported no difference in rates of ROSC between nasal and IV epinephrine, while another reported highest rates of ROSC and coronary perfusion pressure (CPP) with highdose epinephrine in conjunction with low-dose phentolamine [48,49].…”

Section: Nasal Epinephrinementioning

confidence: 99%

Cardiac Agents during Neonatal Cardiopulmonary Resuscitation

Ramsie,

Cheung,

O’Reilly

et al. 2024

Neonatology

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Background: Epinephrine (adrenaline) is currently the only cardiac agent recommended during neonatal resuscitation. The inability to predict which newborns are at risk of requiring resuscitative efforts at birth has prevented the collection of large, high-quality human data. Summary: Information on the optimal dosage and route of epinephrine administration is extrapolated from neonatal animal studies and human adult and pediatric studies. Adult resuscitation guidelines have previously recommended vasopressin use; however, neonatal studies needed to create guidelines are lacking. A review of the literature demonstrates conflicting results regarding epinephrine efficacy through various routes of access as well as vasopressin during asystolic cardiac arrest in animal models. Vasopressin appears to improve hemodynamic and post-resuscitation outcomes compared to epinephrine in asystolic cardiac arrest animal models. Key Messages: The current neonatal resuscitation guidelines recommend epinephrine be primarily given via the intravenous or intraosseous route, with the endotracheal route as an alternative if these routes are not feasible or unsuccessful. The intravenous or intraosseous dose ranges between 0.01 and 0.03 mg/kg, which should be repeated every 3–5 min during chest compressions. However, the optimal dosing and route of administration of epinephrine remain unknown. There is evidence from adult and pediatric studies that vasopressin might be an alternative to epinephrine; however, the neonatal data are scarce.

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Effect of dose on the nasal absorption of epinephrine during cardiopulmonary resuscitation

Cited by 15 publications

References 7 publications

Efficacy of Intravenous, Endotracheal, or Nasal Adrenaline Administration During Resuscitation of Near-Term Asphyxiated Lambs

Efficacy of Intravenous, Endotracheal, or Nasal Adrenaline Administration During Resuscitation of Near-Term Asphyxiated Lambs

Approximate Weight of 1:1000 Topical Epinephrine on Wrung‐Out Epinephrine‐Soaked Pledgets

Cardiac Agents during Neonatal Cardiopulmonary Resuscitation

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