Is adrenaline effective via the endotracheal tube (ETT) at birth?

Adrenaline, when administered via the endotracheal tube (ETT) at birth, is not considered effective. This is primarily due to concerns about absorption and pharmacokinetics. When adrenaline is given through the ETT, the medication does not reach systemic circulation effectively enough to produce the desired cardiovascular effects.

The preferred route of administration for adrenaline during resuscitation, especially in newborns, is intravenous (IV) or intraosseous (IO) because these routes ensure more reliable and effective delivery of the medication directly into the bloodstream. Establishing venous access for intravenous administration is a priority during neonatal resuscitation as it provides the fastest way to achieve the desired physiological response.

While there may be some circumstances in which ETT administration is considered as a last resort, the current guidelines and evidence support the idea that ETT delivery of adrenaline is not sufficient for the therapeutic needs of newborns requiring resuscitation at birth.