Plasma epinephrine levels after epinephrine administration using different tracheal administration techniques in an adult CPR porcine model

Aim: Guidelines for newborn resuscitation state that if the heart rate does not increase despite adequate ventilation and chest compressions, adrenaline administration should be considered. However, controversy exists around the safety and effectiveness of adrenaline in newborn resuscitation. The aim of this review was to summarise a selection of the current knowledge about adrenaline during resuscitation and evaluate its relevance to newborn infants. Methods: A search in PubMed, Embase, and Google Scholar until September 1, 2015, using search terms including adrenaline/epinephrine, cardiopulmonary resuscitation, death, severe brain injury, necrotizing enterocolitis, bronchopulmonary dysplasia, and adrenaline versus vasopressin/placebo. Results: Adult data indicate that adrenaline improves the return of spontaneous circulation (ROSC) but not survival to hospital discharge. Newborn animal studies reported that adrenaline might be needed to achieve ROSC. Intravenous administration (10-30 μg/kg) is recommended; however, if there is no intravenous access, a higher endotracheal dose (50-100 μg/kg) is needed. The safety and effectiveness of intraosseous adrenaline remain undetermined. Early and frequent dosing does not seem to be beneficial. In fact, negative hemodynamic effects have been observed, especially with doses ≥30 μg/kg intravenously. Little is known about adrenaline in birth asphyxia and in preterm infants, but observations indicate that hemodynamics and neurological outcomes may be impaired by adrenaline administration in these conditions. However, a causal relationship between adrenaline administration and outcomes cannot be established from the few available retrospective studies. Alternative vasoconstrictors have been investigated, but the evidence is scarce. Conclusion: More research is needed on the benefits and risks of adrenaline in asphyxia-induced bradycardia or cardiac arrest during perinatal transition.

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“…This recommendation is based on a small number of non-neonatal animal studies [53,54,55,56] and human case series [5,16,57]. …”

Section: Areas Of Controversymentioning

confidence: 99%

Evidence on Adrenaline Use in Resuscitation and Its Relevance to Newborn Infants: A Non-Systematic Review

et al. 2016

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“…[23 ]. The recent change in recommendations away from intratracheal delivery of resuscitation drugs towards the use of intraosseous access needles removes another argument for mandatory endotracheal intubation [1,24].…”

Section: Preclinical Airway Managementmentioning

confidence: 99%

Pediatric resuscitation

Nicolaï¹

2008

Current Opinion in Anaesthesiology

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Resuscitation of 'depressed' near-term neonates should be started with an oxygen content of less than 100%, and only change to 100% if the child remains bradycardic and cyanotic. A neonate who can be resuscitated with room air will receive no benefit from 100% oxygen and may even have a worse outcome. If the first responder in a pediatric emergency is out of training with pediatric intubation he or she should feel reassured that resuscitation without an attempt at endotracheal intubation is acceptable. Presently, hypothermia in neonates after birth asphyxia should be used within controlled studies, or at least follow the protocols of published studies and be performed in specialized centers.

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“…Um exemplo é a hipertensão pós-ressuscitação 27 , que ocorre pela lenta absorção intrapulmonar da adrenalina, ou a hipotensão diastólica resultante do efeito β-agonista dessa mesma droga, gerando hipoperfusão coronariana. Outro importante fator negativo sobre o uso de drogas pela via TET é que as compressões torácicas devem ser suspensas no momento da ad-ministração de medicações 28 . Porém, em pacientes sem outro acesso vascular e já intubados, a administração de drogas lipossolúveis (atropina, naloxone, epinefrina e lidocaína -ANEL) via TET é ainda aceita pelo recente guia.…”

Section: Medicamentos Usados Durante a Reanimação Cardiorrespiratóriaunclassified

The new guidelines for cardiopulmonary resuscitation: a critical analysis

Zorzela¹,

Garros²,

Caen³

2007

J Pediatr (Rio J)

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Objetivo: Descrever as novas recomendações da American Heart Association (AHA), baseado em evidências científicas organizadas pelo Comitê Internacional de Reanimação, endossado e disseminado por entidades norte-americanas e européias. Fontes dos dados: Os guias para suporte básico e avançado de vida em pediatria publicados nas revistas Circulation em novembro de 2005 foram revisados, bem como as subseqüentes publicações sobre o mesmo tópico usando as palavras-chave cardiac arrest, basic life support, advanced life support, cardiopulmonary resuscitation e pediatric resuscitation, através dos métodos de busca PubMed e MEDLINE. Síntese dos dados: As maiores alterações foram na área de suporte básico de vida. O novo guia enfatiza a relação compressão torácica/ventilação para os profissionais da saúde treinados, que passa a ser 15:2 em todas as idades, exceto neonatos. É ressaltada a importância das compressões torácicas fortes e rápidas e a necessidade de se evitar a hiperventilação durante e após a parada cardiorrespiratória. O uso de megadoses de adrenalina foi retirado, bem como outras orientações. Conclusão: O guia mais recente de reanimação em pediatria da AHA tem como foco principal o atendimento básico pré-hospitalar. Está baseado na melhor evidência científica disponível, porém futuras pesquisas são necessárias para corroborar essas mudanças e trazer novas evidências para os futuros protocolos.

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Plasma epinephrine levels after epinephrine administration using different tracheal administration techniques in an adult CPR porcine model

Cited by 7 publications

References 38 publications

Evidence on Adrenaline Use in Resuscitation and Its Relevance to Newborn Infants: A Non-Systematic Review

Evidence on Adrenaline Use in Resuscitation and Its Relevance to Newborn Infants: A Non-Systematic Review

Pediatric resuscitation

The new guidelines for cardiopulmonary resuscitation: a critical analysis

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