When an IV line isn’t readily available, drugs can be administered into the respiratory system through an endotracheal (ET) tube. This route allows uninterrupted resuscitation efforts and avoids such complications as coronary artery laceration, cardiac tamponade, and pneumothorax, which can occur when emergency drugs are administered intracardially.

However, a drug given endotracheally typically produces lower blood levels of the drug than the same dose of the drug given IV. According to the 2010 American Heart Association guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care, studies show that these lower blood levels may actually be detrimental to the patient. For example, epinephrine administered endotracheally may produce transient beta-adrenergic effects, causing vasodilation and subsequent hypotension and reducing the patient’s chances of survival. Because of this, the IV or intraosseous (I.O.) routes are preferred because they provide more predictable drug delivery and pharmacologic effect, even though some resuscitation drugs can be administered endotracheally.¹

When IV or I.O. access can’t be established, epinephrine, vasopressin, and lidocaine may be administered endotracheally during cardiac arrest. Typically, the dose given by the ET route is 2 to 2½ times the recommended IV dose. The drug should be diluted in 5 to 10 mL of sterile water or normal saline solution and then injected directly into the ET tube. Better absorption may occur when epinephrine and lidocaine are diluted in sterile water instead of normal saline solution.¹

Drugs given endotracheally are usually administered in an emergency situation by a doctor, an emergency medical technician, or a critical care nurse. Although guidelines may vary with state, county, or city regulations, the basic administration method is the same. The drugs may be given using either the syringe method or the adapter method. Usually used for bronchoscopy suctioning, the swivel adapter can be placed on the end of the tube and, while ventilation continues through a bag-valve device, the drug can be delivered through the closed stopcock. (See Administering drugs endotracheally.)