Pharmacokinetics and pharmacodynamics of endotracheal versus supraglottic airway epinephrine in a healthy neonatal piglet model.

Background: Epinephrine is currently the only vasopressor recommended for use during neonatal resuscitation. Epinephrine can be administered via intravenous, intraosseous, or endotracheal tube (ETT) route during cardiopulmonary resuscitation (CPR). Supraglottic airway (SGA) may be a novel route of epinephrine administration. This study aimed to compare the pharmacokinetics and pharmacodynamics of 0.1 mg/kg epinephrine administered via ETT, SGA top end, and SGA bottom end.

Design/methods: Newborn piglets (n = 5/group) were anesthetized, randomized to SGA or tracheostomy, then surgically instrumented. Piglets randomized to SGA underwent another round of randomization following stabilization to receive epinephrine at the top or bottom of the SGA. Heart rate (HR), arterial blood pressure, carotid blood flow, and cardiac function (e.g., stroke volume and ejection fraction) were continuously recorded throughout the experiment. Blood was collected prior to drug administration and throughout the observation period for pharmacodynamics and pharmacokinetic analysis.

Results: Significant changes in hemodynamic parameters of HR, carotid blood flow, and cardiac function were only observed following ETT administration of epinephrine, while pharmacokinetic parameters were not different between ETT, SGA top, or SGA bottom.

Conclusion: There were no differences in pharmacokinetic parameters between ETT, SGA top, or SGA bottom routes of epinephrine administration in neonatal piglets.

Impact: Endotracheal tube (ETT) epinephrine results in significant hemodynamic parameters changes, whereas supraglottic airway (SGA) epinephrine did not produce the same hemodynamic effects, despite similar pharmacokinetic profiles. Systematic comparison of pharmacokinetics and pharmacodynamics of epinephrine via SGA versus ETT identifying potential limitations of SGA for epinephrine administration. The study raises important questions about the effectiveness of SGA for epinephrine administration during neonatal resuscitation. This research could influence future resuscitation guidelines and drive further studies to explore alternative dosing strategies or methods to improve the efficacy of SGA epinephrine. Further experiments examining SGA epinephrine during neonatal cardiopulmonary resuscitation are warranted.