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July 10, 1981

Intracardiac Injections During Resuscitation-Reply

JAMA. 1981;246(2):123-124. doi:10.1001/jama.1981.03320020017009

In Reply.—  The comments offered by Drs Keszler and Carroll are much appreciated in that they point out the inadvertent omission from our article of important information. The drugs that were given by ICIs were primarily epinephrine and, less often, calcium chloride. Both were diluted in 10 mL, and their administration by this route was accomplished in about 5 s. Sodium bicarbonate was not given by ICI.In my opinion, rapid access to the more "central" venous sites is not as universally available as Drs Keszler and Carroll suggest. In fact, I suspect that their lack of exposure to this problem is a reflection of exceptional local facilities.Although I agree that emergency drug administration via an endotracheal tube should be attempted before resorting to the intracardiac route, I find no evidence—other than anecdotal—to support this preference during human resuscitation.Finally, I would attempt to reassure Dr Yakaitis by reiterating