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Endotracheal administration of epinephrine during cardiopulmonary resuscitation.

Sir .—The report of Greenberg et al (Journal1981;135:767-768) on endotracheally administered epinephrine is an important contribution to the management of cardiovascular collapse in neonates. The endotracheal route is based on successful studies, mainly in laboratory animals. 1-5 The advantages mentioned by Greenberg et al are obvious. Therefore, we have routinely used the endotracheal route for cardiopulmonary resuscitation during the last six months. We gave epinephrine endotracheally to three severely asphyxiated newborn infants, as well as to a 4-week-old preterm baby (820 g) who also had septic shock. They all had bradycardia that did not respond to ventilation with 100% oxygen, to bicarbonate infusion, or to heart compression. Epinephrine (ie, epinephrine bitartrate, 0.1 mg/mL of epinephrine base) was injected directly into the tracheal tube, and ventilation was continued. Within seconds, a normal heart rhythm returned in all infants. Greenberg et al pointed out the serious complications that might be associated