• Military medicine · Feb 2025

    Effects of Endotracheal Weight-Based Epinephrine on Pharmacokinetics and Survival in Swine With a Cardiac Arrest.

    • Don Johnson, Dawn Blouin, Karen Brocklehurst, and Joseph O'Sullivan.
    • The Geneva Foundation, Tacoma, Washington 98402, USA.
    • Mil Med. 2025 Feb 3.

    BackgroundThe aims of this study were to compare concentration maximum (Cmax), time to Cmax, area under the curve, mean concentration over 4 minutes, and frequency and time to return of spontaneous circulation (ROSC) by group.MethodsThis was a prospective, experimental study using swine. In total, 40 pigs (n = 8 per group) were assigned as follows: 0.1 mg/kg endotracheal (ET) tube, 1 mg intravenous (IV), 2 mg ET, Cardio Pulmonary Resuscitation (CPR) + defibrillation (CPR + defib), and CPR-Only. Pigs were placed in arrest for 2 minutes, CPR was then initiated for 2 minutes, and epinephrine was then administered and repeated every 4 minutes or until ROSC. Blood samples were collected over 4 minutes. Defibrillation was initiated at 3 minutes and continued every 2 minutes for 30 minutes or until ROSC. CPR + defib and CPR-Only Groups served as controls. The CPR + defib Group had defibrillations but did not receive epinephrine. The CPR-Only Group did not receive defibrillations or epinephrine.Results And ConclusionsThe Cmax and area under the curve were significantly higher in the IV Group compared to the 0.1 mg/kg ET Group (P < .05). The time to Cmax was significantly longer in the 0.1 mg/kg Group than the 1 mg IV Group (P = .03). The mean concentration of the 1 mg IV Group was higher than the 0.1 mg/kg ET Group until 180 and 240 seconds. There was no significant difference between the groups relative to time to ROSC (P > .05). Return of spontaneous circulation frequencies were: 0.1 mg/kg ET Group (7 of 8); 1 mg IV Group (5 of 8); and 2 mg ET Group (1 of 8), and both CPR + defib and CPR-Only (0 out of 8). This study challenges the current guidelines relative to ET epinephrine administration. Based on our ROSC data, the 0.1 mg/kg dose of epinephrine by ET should be used as a first-line intervention.Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2025. This work is written by (a) US Government employee(s) and is in the public domain in the US.

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