Effect of dose on the nasal absorption of epinephrine during cardiopulmonary resuscitation: Am J Emerg Med 1996; 14/2: 133–138

Abstract

Abstract Delay in epinephrine administration during cardiopulmonary resuscitation (CPR) due to technical difficulties in obtaining an access site may be detrimental. To avoid this potential delay, we have previously shown that intranasal administration of phentolamine and epinephrine is a rapidly obtainable and feasible route of administration during CPR. The objective of this study was to determine the optimal dose of phentolamine and epinephrine to be administered during CPR. A randomized blinded dose ranging study was performed in a controlled laboratory environment. Thirty-six mongrel dogs were randomized to one of the following dosage regimens: phentolamine, 0.25 or 2.5 mg/kg/nostril; epinephrine, 0.075, 0.75, or 7.5 mg/kg/nostril. Phentolamine was administered intranasally 1 minute before the intranasal administration of epinephrine to improve absorption. Each dog underwent 3 minutes of ventricular fibrillation followed by 7 minutes of closed chest CPR. Epinephrine was administered at 3 minutes of CPR. Data from 26 dogs were included for analysis. Treatment B (0.25 and 7.5 mg/kg/nostril of phentolamine and epinephrine, respectively) produced the greatest elevation in coronary perfusion pressure (17 ± 11 vs 4 ± 3 mm Hg for the next highest group, P 5 5 ) versus 0% to 50% for the other groups (P