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Which resuscitation drugs are effective when given via an ETT?
The preferred routes of drug delivery for infants and children in cardiac arrest are IV and IO. However, there are four “traditional” resuscitation drugs that are effective when administered through the ETT. Those four are l idocaine, a tropine, n aloxone, and e pinephrine. The acronym LANE is an easy way to remember them. V ersed (midazolam) also is useful and is effective when administered via the ETT. Adding this drug to the list yields a different acronym: NAVEL. With the exception of epinephrine, endotracheal doses are the same as intravascular doses. All doses of epinephrine given through the ETT should be a higher dose (0.1 mg/kg).
Various medications and tube devices may be employed during rapid sequence intubation. The most commonly used of these are discussed here.
Etomidate
Etomidate is the most commonly used induction agent for rapid sequence intubation. This medication is a non-barbiturate sedative that depresses central nervous system function by activating gamma-aminobutyric acid (GABA) receptors. The advantages of etomidate therapy include a short onset of action (30 to 60 seconds) and a short half-life (3 to 5 minutes). Etomidate does not affect systemic blood pressure and demonstrates central nervous system (CNS) protective effects such as reduced cerebral blood flow and oxygen uptake.[5] This drug is usually preferable for patients with pre-existing hypotension and trauma.
Ketamine
Ketamine, a phencyclidine derivative, is a noncompetitive antagonist of the N-methyl-D-aspartate (NMDA) receptors, demonstrating analgesic, sympathomimetic, and amnestic properties. This drug has a short onset of action of 1 to 2 minutes and a half-life of 5 to 15 minutes.[6] Ketamine’s effectiveness as a bronchodilator makes it a preferable agent for scenarios involving patients with acute severe asthma.
Propofol
Propofol has multiple mechanisms of action but primarily potentiates GABA receptors. Because it is highly lipid-soluble, it induces sedation within 9 to 50 seconds and has a short half-life of 3 to 10 minutes. Propofol also has anti-convulsive and anti-emetic properties and reduces intracranial pressure, which is beneficial in patients with traumatic brain injury and status epilepticus. Because of such a quick onset of action and short half-life, it is also commonly used as a continuous titratable infusion for sedating mechanically ventilated patients.
DRUGS THAT CAN BE GIVEN VIA THE ENDOTRACHEAL ROUTE
- 1. Lidocaine
- 2. Atropine
- 3. Naloxone
- 4. Epinephrine
- 5. Versed
Sources
- Intubation Endotracheal Tube Medications – Hendrix JM, Regunath H. Intubation Endotracheal Tube Medications. [Updated 2025 Jan 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459276/
- American Heart Association: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Part 10: Pediatric Basic and Advanced Life Support. Circulation 2010;122:S466-S515.
