Use and efficacy of endotracheal versus intravenous epinephrine during neonatal cardiopulmonary resuscitation in the delivery room
Use and efficacy of endotracheal versus intravenous epinephrine during neonatal cardiopulmonary resuscitation in the delivery room
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DOI：
10.1542/peds.2006-0416
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发表时间：
2006-09-01
期刊：
影响因子：
8
通讯作者：
Wyckoff, Myra H.
中科院分区：
文献类型：
--
作者：
Barber, Chad A.;Wyckoff, Myra H.
OBJECTIVE.由于缺乏关于气管内肾上腺素用于新生儿复苏的信息，本研究的目的是：（1）确定产房新生儿气管内肾上腺素使用的频率，以及（2）确定先前推荐的0.01至0.03 mg/kg气管内肾上腺素剂量是否有效地建立自主循环的恢复。对1999年1月至2004年12月期间在产房接受≥ 1剂肾上腺素的所有新生儿进行回顾性分析。复苏期间在产房接受≥ 1剂气管内肾上腺素的婴儿被纳入研究人群，无论他们是否存活到NICU。排除标准包括致命的先天性畸形、院外分娩和病历缺失。在93656名婴儿中，52名新生儿（0.06%）在产房接受了肾上腺素治疗，其中5名符合排除标准。在其余47名婴儿中，44名（94%）通过气管内导管接受了第一剂。44例中只有14例（32%）在气管插管给予肾上腺素后恢复自主循环。在剩下的30名婴儿中，23名（77%）在最初气管内插管肾上腺素失败后通过静脉注射肾上腺素恢复了自主循环。除了新生儿重症监护病房入院时血糖较低（52 mg % vs 113 mg%）外，气管插管与静脉注射肾上腺素的新生儿在临床特征上没有差异。当产房需要强化复苏时，经常使用气管内肾上腺素。先前推荐的0.01至0.03 mg/kg的气管内肾上腺素剂量通常无效。可能需要更高的气管内剂量来提高疗效。需要进行前瞻性研究以确定最佳气管内肾上腺素给药方案。在获得这些信息之前，静脉给药应是首选的给药途径。
OBJECTIVE. Given the paucity of information regarding endotracheal epinephrine for newborn resuscitation, the objectives of this study were: (1) to determine the frequency of endotracheal epinephrine use in newborns in the delivery room, and (2) to determine whether the previously recommended dose of 0.01 to 0.03 mg/kg of endotracheal epinephrine is effective in establishing a return of spontaneous circulation.PATIENTS AND METHODS. A retrospective review was conducted for all neonates who received >= 1 dose of epinephrine in the delivery room between January 1999 and December 2004. Infants who received >= 1 dose of endotracheal epinephrine in the delivery room during resuscitation were included in the study population whether or not they survived to be admitted to the NICU. Exclusion criteria included lethal congenital anomalies, delivery outside the hospital, and missing medical charts.RESULTS. Of 93 656 infants, 52 neonates (0.06%) received epinephrine in the delivery room, 5 of whom met exclusion criteria. Of the remaining 47 infants, 44 (94%) received the first dose via the endotracheal tube. Only 14 (32%) of 44 achieved return of spontaneous circulation after endotracheal tube administration of epinephrine. Of the 30 remaining infants, 23 (77%) had return of spontaneous circulation with intravenous epinephrine after initially failing endotracheal tube epinephrine. There were no differences in clinical characteristics between newborns who responded to endotracheal tube versus intravenous epinephrine except for a lower blood glucose on NICU admission (52 vs 113 mg%).CONCLUSIONS. Endotracheal epinephrine is frequently used when intensive resuscitation is required in the delivery room. The previously recommended endotracheal epinephrine dose of 0.01 to 0.03 mg/kg is often ineffective. Higher endotracheal doses will likely be needed to improve efficacy. A prospective study is needed to determine the best endotracheal epinephrine dosing regimen. Until such information is available, intravenous administration should be the preferred route of delivery.