Use of Initial Endotracheal Versus Intravenous Epinephrine During Neonatal Cardiopulmonary Resuscitation in the Delivery Room: Review of a National Database

Cecilie Halling; Sara Conroy; Tia Raymond; Elizabeth E Foglia; Mary Haggerty; Linda L Brown; Myra H Wyckoff; American Heart Association’s Get With The Guidelines–Resuscitation Investigators

doi:10.1016/j.jpeds.2024.114058

Use of Initial Endotracheal Versus Intravenous Epinephrine During Neonatal Cardiopulmonary Resuscitation in the Delivery Room: Review of a National Database

J Pediatr. 2024 Apr 16:271:114058. doi: 10.1016/j.jpeds.2024.114058. Online ahead of print.

Authors

Cecilie Halling¹, Sara Conroy², Tia Raymond³, Elizabeth E Foglia⁴, Mary Haggerty⁴, Linda L Brown⁵, Myra H Wyckoff⁶; American Heart Association’s Get With The Guidelines–Resuscitation Investigators

Affiliations

¹ Division of Neonatology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, OH. Electronic address: Cecilie.halling@nationwidechildrens.org.
² Center for Perinatal Research and the Ohio Perinatal Research Network, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH; Biostatistics Resource at Nationwide Children's Hospital, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH.
³ Department of Pediatrics, Cardiac Critical Care, Medical City Children's Hospital, Dallas, TX.
⁴ Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA.
⁵ Department of Emergency Medicine, Alpert Medical School of Brown University, Hasbro Children's Hospital, Providence, RI; Department of Pediatrics, Alpert Medical School of Brown University, Hasbro Children's Hospital, Providence, RI.
⁶ Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical School, Dallas, TX.

PMID: 38631614
DOI: 10.1016/j.jpeds.2024.114058

Abstract

Objective: To assess whether initial epinephrine administration by endotracheal tube (ET) in newly born infants receiving chest compressions and epinephrine in the delivery room (DR) is associated with lower rates of return of spontaneous circulation (ROSC) than newborns receiving initial intravenous (IV) epinephrine.

Study design: We conducted a retrospective review of neonates receiving chest compressions and epinephrine in the DR from the AHA Get With The Guidelines-Resuscitation registry from October 2013 through July 2020. Neonates were classified according to initial route of epinephrine (ET vs IV). The primary outcome of interest was ROSC in the DR.

Results: In total, 408 infants met inclusion criteria; of these, 281 (68.9%) received initial ET epinephrine and 127 (31.1%) received initial IV epinephrine. The initial ET epinephrine group included those infants who also received subsequent IV epinephrine when ET epinephrine failed to achieve ROSC. Comparing initial ET with initial IV epinephrine, ROSC was achieved in 70.1% vs 58.3% (adjusted risk difference 10.02; 95% CI 0.05-19.99). ROSC was achieved in 58.3% with IV epinephrine alone, and 47.0% with ET epinephrine alone, with 40.0% receiving subsequent IV epinephrine.

Conclusions: This study suggests that initial use of ET epinephrine is reasonable during DR resuscitation, as there were greater rates of ROSC compared with initial IV epinephrine administration. However, administration of IV epinephrine should not be delayed in those infants not responding to initial ET epinephrine, as almost one-half of infants who received initial ET epinephrine subsequently received IV epinephrine before achieving ROSC.

Keywords: delivery room resuscitation; endotracheal and intravenous epinephrine use; neonatal resuscitation.