[Endobronchial administration of adrenaline in preclinical cardiopulmonary resuscitation]

The present clinical study was designed to investigate the effectiveness of epinephrine when administered endobronchially (e. b.) in patients undergoing out-of-hospital cardiopulmonary resucitation (CPR). Plasma catecholamine measurements during and following CPR in 30 patients revealed plasma levels of epinephrine and norepinephrine with tremendous variations and elevated, sometimes, for nearly 1,000 fold when compared to normal resting levels. In patients with ventricular fibrillation (VF) native epinephrine concentrations (23.5 +/- 20.4 ng/ml) were significantly different from asystolic victims (2.1 +/- 1.2 ng/ml). This finding once more supports the importance of early defibrillation as main therapeutical step in VF. When epinephrine (2-3 mg) was instilled endobronchially shortly after endotracheal intubation therapeutic concentrations of more than 10 ng/ml of epinephrine were measured when the first venous access was achieved. In 7 patients with successful CPR e. b. epinephrine was the only pharmacological therapy provided to support the cardiovascular system. Under these circumstances plasma epinephrine levels remained within the therapeutic range of 10-20 ng/ml for about 30 minutes. By these clinical findings it becomes clear that e. b. epinephrine (2-3 mg in 5-10 ml of NaCl 0.9%) instilled deeply by a catheter following intubation is the pharmacological therapy of choice in asystolic patients.