Application of a cuirass and institution of biphasic extra-thoracic ventilation by gear-protected physicians.
OBJECTIVE
To evaluate the speed by which cuirass application, followed by biphasic extra-thoracic ventilation, can be instituted by full anti-chemical protective gear-wearing physicians.


METHODS
Ten physicians of variable subspecialties applied a cuirass on an adult volunteer and instituted biphasic extra-thoracic ventilation, using the RTX respirator (Medivent, London, UK). Endotracheal (ET) intubation and manual ventilation of a mannequin and its ventilation was comparatively assessed. Performances were conducted in a prospective, crossover, randomized manner. Times to successful applications as well as failure rates were recorded.


RESULTS
Cuirass application was performed more rapidly (102 +/- 9 s, 177 +/- 31 s, respectively, P <.01) and with a slightly lower failure rate than ET intubation.


CONCLUSIONS
Physicians wearing full anti-chemical protective gear applied the cuirass and instituted biphasic extra-thoracic ventilation faster than ET intubation and manual positive pressure ventilation. Extra-thoracic ventilation should be further evaluated as an option for emergent respiratory support during toxic mass casualty events.
Ben-Abraham
Ron
R
Department of Anesthesiology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Israel.
Gur
Ilan
I
Bar-Yishay
Ephraim
E
Lin
Guy
G
Blumenfeld
Amir
A
Kalmovich
Boaz
B
Weinbroum
Avi A
AA
D000328:Adult; D002619:Chemical Warfare Agents / Q000633:toxicity*; D018592:Cross-Over Studies; D004190:Disasters; D006801:Humans; D019570:Inhalation Exposure / Q000009:adverse effects*; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000592:standards*; D007557:Israel; D008511:Medicine / Q000295:instrumentation / Q000592:standards; D011175:Positive-Pressure Respiration / Q000295:instrumentation*; D011361:Professional Competence; D012134:Respiratory Protective Devices; D013038:Specialization; D013996:Time and Motion Studies; D012122:Ventilators, Mechanical
D002619:Chemical Warfare Agents