Endotracheal epinephrine is unreliable

Part 14: Pediatric Advanced Life Support

“…Some studies showed it to be as effective as vascular administration 193,198,199 while other studies have not found it to be as effective. 194 -196,200 Animal studies [201][202][203][204][205][206] suggested that a higher dose of epinephrine is required for endotracheal than for intravascular administration because the lower epinephrine concentrations achieved when the drug is delivered by the endotracheal route may produce predominant transient peripheral ␤ 2 -adrenergic vasodilating effects. These effects can be detrimental, and cause hypotension, lower coronary artery perfusion pressure and flow, and a reduced potential for ROSC.…”

Use and Efficacy of Endotracheal Versus Intravenous Epinephrine During Neonatal Cardiopulmonary Resuscitation in the Delivery Room

“…Previous International Liaison Committee on Resuscitation (ILCOR) guidelines from 1999 7 (which served as the basis for previous American Academy of Pediatrics/American Heart Association Neonatal Resuscitation Program [NRP] guidelines 8 ) recommended administration of 0.1 to 0.3 mL/kg of a 1:10 000 epinephrine solution (0.01-0.03 mg/kg) either via the endotracheal tube (ETT) or intravenously for an inadequate heart rate (Ͻ60 beats per minute) despite adequate ventilation and chest compressions. Although adult and animal data suggest that epinephrine delivery via the endotracheal tube is less efficacious than intravenous, [9][10][11][12] the endotracheal route was included as an option because intravenous access is rarely available immediately at the time of delivery. New ILCOR guidelines emphasize that administration of epinephrine via the umbilical vein is preferable to endotracheal administration and allow that if no intravenous access is available, higher ETT epinephrine doses (Յ0.1 mg/kg) may be used.…”

The Use of a Powered Device for Intraosseous Drug and Fluid Administration in a National EMS: A 4-Year Experience

“…2 The use of the intrapulmonary route for drug delivery, although relatively common in resuscitation scenarios, is limited by the need for endotracheal tube placement, by the limited number of medications that can be administered and by inconsistent absorption. 3 It has been discouraged in the latest update of the advanced cardiac life support (ACLS) by the American Heart Association. 4 The intraosseous route is an alternative method for intravenous (IV) access.…”

“…Studies of the pharmacokinetics of IOI show it to be comparable with IV administration both in maximal concentration and speed achieved after identical dosing. 3,[7][8][9][10][11][12][13][14] The November 2005 AHA guidelines 4 even compare it with central venous administration stating that "Intraosseous (IO) cannulation provides access to a noncollapsible venous plexus, enabling drug delivery similar to that achieved by central venous access".…”