If IV/IO access is not available, what is the endotracheal dose of epinephrine for pediatric cardiac arrest?

• A. 0.1 mg/kg ETT q3-5 min
• B. 0.01 mg/kg ETT q3-5 min
• C. 0.5 mg/kg ETT q3-5 min
• D. 1 mg/kg ETT q3-5 min

Answer: (A)

Endotracheal epinephrine in pediatric arrest requires a higher dose because absorption from the airway is unreliable. The dose used via the endotracheal route is 0.1 mg/kg of a 1:10,000 epinephrine solution, given every 3–5 minutes during CPR. This is ten times the IV/IO dose (0.01 mg/kg), designed to achieve a similar systemic effect despite poor mucosal uptake. So the best match is 0.1 mg/kg via the endotracheal route every 3–5 minutes. Doses like 0.01 mg/kg would be too small for ET administration, while 0.5 mg/kg or 1 mg/kg are far above recommended amounts and could cause dangerous side effects. If IV/IO access becomes available, switch to IV/IO dosing.