Background: During CPR, intravenous epinephrine increases coronary perfusion pressure and cerebral perfusion pressure. We have recently shown (Crit. Care Med 1992;20:1582-7) that endotracheal epinephrine, might cause a detrimental effect by decreasing blood pressure

Objective: To define the hemodynamic effects of endotracheal epinephrine.

Design: Prospective, randomized, laboratory comparison of epinephrine (0.02 mg/kg diluted to a total volume of 10 ml with normal saline) and normal saline (10 ml) injected endotracheally.

Setting: Large animal research facility of a university medical center.

Subjects and interventions: Epinephrine (0.02 mg/kg) diluted to a total volume of 10 ml of normal saline, alternating with normal saline in a volume of 10 ml was injected into the ET tube of six anesthetized dogs. Each dog served as its own control and received the different regimens in different sequences at least one week apart. Arterial blood samples for blood gases were collected before and 0.25, 0.5, 0.75, 1, 2, 3, 4, 5, 10, 15, 20, 25, 30, and 60 minutes after drug administration. Heart rate and arterial blood pressure were continuously monitored with a polygraph recorder.

Measurements and Main Results: Endotracheal epinephrine was associated with a significant decrease in diastolic and mean arterial pressures (P<0.01), and a significantly higher heart rate (P<0.003), compared to the effects demonstrated when normal saline was given endotracheally.

Conclusions: Endotracheal epinephrine (0.02 mg/kg) might have a detrimental effect in CPR The optimal ET dose should reevaluated.