Endotracheal drug delivery followed by a 90-degree torso tilt in a swine model of cardiac arrest

• Published in: Prehospital emergency care 1997, Vol.1 (4), p.227-232
• Main Authors: Killian, Carol Ann, Robins, Amy L., Menegazzi, James J., Scheatzle, Mark D., Novick, Lee Ann
• Format: Article
• Language: English
• Subjects: Administration, Inhalation; Animals; Anti-Arrhythmia Agents - administration & dosage; Anti-Arrhythmia Agents - blood; cardiac arrest; Cardiopulmonary Resuscitation; endotracheal drug administration; Heart Arrest - blood; Heart Arrest - drug therapy; Infusions, Intravenous; lidocaine; Lidocaine - administration & dosage; Lidocaine - blood; Posture; Prospective Studies; Random Allocation; Swine; torso tilt; Trachea
• ISSN: 1090-3127; 1545-0066
• DOI: 10.1080/10903129708958815

Objectives. Prehospital providers are often unable to obtain intravenous (IV) access in cardiac arrest victims. While several drugs can be administered via the endotracheal (ET) route, serum drug levels are lower than those obtained with the IV route. The authors hypothesized that a 90-degree torso tilt after ET drug administration would increase drug levels. Methods. A randomized, prospective, unblinded laboratory trial was conducted. Twenty-three mixed-breed domestic swine (20-25 kg) were sedated, anesthetized, instrumented, shocked into cardiac arrest, and randomized into three groups. Lidocaine was administered either IV (1.5 mg/kg), traditional ET (4.5 mg/kg), or ET followed by a 5-second 90-degree upright torso tilt (4.5 mg/kg). While standard CPR was performed, lidocaine levels were obtained at 0.5,1,2,3,4, and 5 minutes after administration. Repeated-measures ANOVA was used for data analysis (alpha = 0.05). Results. Experimental ET compared with traditional ET administration produced significantly higher levels at all time points except 0.5 minutes. Comparing experimental ET with IV administration yielded significantly higher levels for the IV route at 0.5 and 1 minute and for the experimental ET route at 4 and 5 minutes. IV lidocaine administration resulted in significantly higher levels at 0.5,1, and 2 minutes when compared with traditional ET administration. Conclusions. Endotracheal instillation of lidocaine followed by a 90-degree torso tilt resulted in better drug absorption, as evidenced by higher serum lidocaine levels, than did traditional recumbent ET delivery at all but the earliest time point and produced more sustained lidocaine levels than IV administration at 4 and 5 minutes. ET drug delivery followed by a 5-second 90-degree torso tilt and the mechanisms for this enhanced absorption warrant further investigation.