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

Pediatric Research volume 98, pages 1539–1544 (2025)Cite this article

Abstract

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.

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Fig. 1
Fig. 2: Application of epinephrine with a supraglottic airway (SGA).
Fig. 3: Changes in hemodynamic parameters following epinephrine administration.
Fig. 4: Pharmacokinetics of various routes of administration.

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Data availability

All data generated or analyzed during this study are included in this published article. Data used to generate the results reported in this study will be made available following publication from the corresponding author upon reasonable request.

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Funding

We would like to thank our funding agencies: the study was supported by a project grant from the Canadian Institutes of Health Research. MR is a recipient of the Canadian Institutes of Health Research Canada Graduate Scholarships-Master’s program, Walter H Johns Graduate Fellowship, Alberta Graduate Excellence Scholarship, and Medical Sciences Graduate Program Scholarship.

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Authors and Affiliations

  1. Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, AB, Canada

    Marwa Ramsie, Po-Yin Cheung, Tze-Fun Lee, Megan O’Reilly & Georg M. Schmölzer

  2. Department of Pediatrics, University of Alberta, Edmonton, AB, Canada

    Marwa Ramsie, Po-Yin Cheung & Georg M. Schmölzer

Authors
  1. Marwa Ramsie
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  2. Po-Yin Cheung
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  3. Tze-Fun Lee
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  4. Megan O’Reilly
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  5. Georg M. Schmölzer
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Contributions

Conception and design: G.M.S., P.Y.C., M.O.R., M.R., and T.F.L. Collection and assembly of data: G.M.S., P.Y.C., M.O.R., M.R., and T.F.L. Analysis and interpretation of the data: G.M.S., P.Y.C., M.O.R., M.R., T.F.L. Drafting of the first draft: MR. Critical revision of the article for important intellectual content: G.M.S., P.Y.C., M.O.R., M.R., and T.F.L. Final approval of the article: G.M.S., P.Y.C., M.O.R., M.R., and T.F.L.

Corresponding author

Correspondence to Georg M. Schmölzer.

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Ramsie, M., Cheung, PY., Lee, TF. et al. Pharmacokinetics and pharmacodynamics of endotracheal versus supraglottic airway epinephrine in a healthy neonatal piglet model. Pediatr Res 98, 1539–1544 (2025). https://doi.org/10.1038/s41390-025-03960-y

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