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May 26, 1993

Cardiopulmonary Resuscitation-Reply

Author Affiliations

University of Washington Medical Center Seattle American Heart Association
Eastern Virginia Medical School Norfolk American Heart Association

JAMA. 1993;269(20):2628. doi:10.1001/jama.1993.03500200039025

In Reply.  —We know that endotracheal drug administration is inferior to intravenous administration and should only be used when personnel cannot obtain intravenous access. However, when endotracheal drug administration is the only possibility, should we inject the agents through the proximal port of the endotracheal tube or through a catheter threaded down the endotracheal tube? Administration through a catheter is more cumbersome and time-consuming. Does catheter administration produce better drug levels in the circulation? Researchers have not observed consistent results regarding which technique produces superior drug delivery.The study quoted by Dr Muñiz observed no differences in the serum lidocaine levels when lidocaine diluted in saline was administered at four different locations in the lungs: upper end of the endotracheal tube, proximal carina, right main stem bronchus, or right lower lobe bronchus.1 This study was limited by the fact that these were well-perfused patients with normal cardiac outputs. Absorption