Hemodynamic effects of tracheal and intravenous adrenaline in infants with congenital heart anomalies

Background: If intravenous access cannot be accomplished during cardiopulmonary resuscitation in children, tracheal administration of 100 mu g/kg of adrenaline (ten times greater than the intravenous dose) is recommended. Methods: In a randomized crossover study we recorded the hemodynamic effect of a low dose of intravenous adrenaline and a ten times greater tracheal dose. While anesthetized for open heart surgery, fourteen infants received one dose of adrenaline intravenously (0.3 mu g/kg) and the other tracheally (3 mu g/kg). Results: During the first 5 minutes after administration mean arterial pressure (MAP) and heart rate (HR) increased after both intravenous and tracheal administration (P<0.001). The maximum increase in MAP was 28% (17-68%, median and range) after intravenous injection and 20% (6-69%, P<0.05 when compared to intravenous injection) after tracheal instillation. In four infants, MAP increased less than 10% after tracheal instillation The maximum increases in MAP and HR occurred 1 min (1-2 min) after intravenous injection and 3 min (2-4 min) after tracheal instillation (P<0.001). Conclusion: Tracheal administration of 3 mu g/kg adrenaline increased mean arterial blood pressure in infants with congenital cardiac anomalies, but the increase occurred later and was less consistent than after 0.3 mu g/kg of adrenaline given intravenously.