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

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

STUDY DESIGN: We conducted a retrospective review of neonates receiving chest compressions and epinephrine in the delivery room (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 versus IV). The primary outcome of interest was ROSC in the DR.

RESULTS: 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 (aRD) = 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.

CONCLUSION: This study suggests that initial use of ET epinephrine is reasonable during DR resuscitation as there were higher 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 half of infants who received initial ET epinephrine subsequently received IV epinephrine prior to achieving ROSC.