Following a recent discussion
It was stated the ET drug administration in cardiac arrest was ineffective
I asked, being ignorant, why this was.
I obtained no answers
No one is obligated to provide an answer on E-lists



... Certainly not more than the one that ask the questions

So this is what found :


Crit Care Med 2000 Jun;28(6):1815-9 
Endotracheal versus intravenous epinephrine and atropine in out-of-hospital
"primary" and postcountershock asystole.Niemann JT, Stratton SJUCLA School of
Medicine, the Department of Emergency Medicine, Harbor-UCLA Medical Center,
Torrance, CA, USA.STUDY OBJECTIVE: Pulmonary blood flow during cardiac arrest
and cardiopulmonary resuscitation (CPR) is <20% of normal, and transalveolar
drug absorption is likely to be minimal. Animal and clinical CPR studies have
not addressed the use of endotracheal (ET) epinephrine in doses currently
recommended for adults (twice the intravenous dose). The purpose of this study
was to compare the effects of ET and intravenous drugs on cardiac rhythm in
the
prehospital setting. DESIGN: A 3-yr (1995-1997) retrospective review of all
cardiac arrests transported to a single, municipal teaching institution was
performed. PATIENTS: Patients >18 yrs in atraumatic cardiac arrest whose first
documented field rhythm was asystole with time-to-definitive care of < or =10
mins (primary asystole) and patients found in ventricular fibrillation who
developed postcountershock asystole (secondary asystole) were included.
Patients were grouped according to route of drug administration (i.v., ET, or
no drug therapy) as well as rhythm (primary or secondary asystole). A positive
response to drug therapy was defined as any subsequent rhythm other than
asystole during continued prehospital resuscitation. MEASUREMENTS AND MAIN
RESULTS: A total of 136 patients met inclusion criteria. The following groups
were defined: group 1, primary asystole/i.v. drugs (n = 39); group 2,
postcountershock asystole/i.v. drugs (n = 39); group 3, primary asystole/ET
drugs (n = 25); group 4, postcountershock asystole/ET drugs (n = 18); and
group
5, primary or secondary asystole/no drug therapy (n = 15). Significant
differences were not observed between groups with respect to age, gender,
witnessed arrest, frequency of bystander CPR, or time-to-definitive care. The
positive rhythm response rate was significantly greater in group 1 (64%) and
group 2 (69%) (both p < .01) than in Group 3 (12%) or group 4 (11%). The
response rate in the control group was 20% and not significantly different
from
either ET group. The intravenous groups also had a significantly greater rate
of return of spontaneous circulation (17%) when compared with the ET groups
(0%) (p = .005). CONCLUSION: We conclude that the currently recommended doses
of epinephrine and atropine administered endotracheally are rarely
effective in
the setting of cardiac arrest and CPR.Publication Types:   
·       Clinical trial 
Comment in:   
·       Crit Care Med. 2000 Jun;28(6):2144 

 Anything else on the subject out there ?

Charles Brault EMT-P 

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