Endotracheal adrenaline in cardiac arrest due to near-fatal asthma: a case study

United Kingdom statistics for asthma show 1 204 deaths from asthma in 2008 (Asthma UK, 2008). Although death rates from asthma are declining, near-fatal asthma (NFA) still presents a signifcant challenge to emergency responders, with most asthma deaths occurring outside of the hospital (Rodrigo et al, 2004). Restrepo and Peters (2008) define near fatal asthma as ‘typically associated with the presence of hypercapnoea, acidaemia, altered state of consciousness and the development of cardio-respiratory arrest requiring endotracheal intubation and mechanical ventilation’.

NFA is a subtype of asthma with unique risk factors and variable presentation that requires early recognition and aggressive intervention. (Restrepo, 2008). United Kingdom ambulance dispatch records show that around 17 % of ambulance calls are prioritised as breathing diffculties (Clawson, 2008). Of these, around 30 % are identified as being asthmatic. While all of these calls cannot be attributed to NFA, it is reasonable to surmise that paramedics are called to patients with life-threatening asthma and some of these may later be categorised as near-fatal.