title: Examining prehospital intubation for penetrating trauma in a swine hemorrhagic shock model.
abstract: BACKGROUND
  Prehospital intubation does not result in a survival advantage in patients experiencing penetrating trauma, yet resistance to immediate transportation to facilitate access to definitive care remains. An animal model was developed to determine whether intubation provides a survival advantage during severe hemorrhagic shock. We hypothesized that intubation would not provide a survival advantage in potentially lethal hemorrhage.
  
  
  METHODS
  After starting a propofol drip, Yorkshire pigs were intubated (n = 6) or given bag-valve mask ventilation (n = 7) using 100% oxygen. The carotid artery was cannulated with a 14-gauge catheter, and a Swan-Ganz catheter was placed under fluoroscopy using a central venous introducer. After obtaining baseline hemodynamic and laboratory data, the animals were exsanguinated through the carotid line until death. The primary end point was time until death, while secondary end points included volume of blood shed, temperature, cardiac index, mean arterial pressure, lactic acid, base excess, and creatinine levels measured in 10-minute intervals.
  
  
  RESULTS
  There was no difference in time until death between the two groups (51.1 [2.5] minutes vs. 48.5 [2.4] minutes, p = 0.52). Intubated animals had greater volume of blood shed at 30 minutes (33.6 [4.4] mL/kg vs. 28.5 [4.3] mL/kg, p = 0.03), 40 minutes (41.7 [4.7] mL/kg vs. 34.9 [3.8] mL/kg, p = 0.04), and 50 minutes (49.2 [8.6] mL/kg vs. 40.2 [1.0] mL/kg, p = 0.001). In addition, the intubated animals were more hypothermic at 40 minutes (35.5°C [0.4°C] vs. 36.7°C [0.2°C], p = 0.01) and had higher lactate levels (2.4 [0.1] mmol/L vs. 1.8 [0.4] mmol/L, p = 0.04) at 10 minutes. Cardiac index (p = 0.66), mean arterial pressure (p = 0.69), base excess (p = 0.14), and creatinine levels (p = 0.37) were not different throughout the shock phase.
  
  
  CONCLUSIONS
  Intubation does not convey a survival advantage in this model of severe hemorrhagic shock. Furthermore, intubation in the setting of severe hemorrhagic shock may result in a more profuse hemorrhage, worse hypothermia, and higher lactate when compared with bag-valve mask ventilation.
authors.affiliation: Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania 19140, USA.
authors.forename: Sharven
authors.initials: S
authors.lastname: Taghavi
authors.forename: Senthil N
authors.initials: SN
authors.lastname: Jayarajan
authors.forename: Swapnil
authors.initials: S
authors.lastname: Khoche
authors.forename: Jason M
authors.initials: JM
authors.lastname: Duran
authors.forename: Gonzalo E
authors.initials: GE
authors.lastname: Cruz-Schiavone
authors.forename: Richard E
authors.initials: RE
authors.lastname: Milner
authors.forename: Lewis
authors.initials: L
authors.lastname: Holt-Bright
authors.forename: John P
authors.initials: JP
authors.lastname: Gaughan
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Rappold
authors.forename: Lars O
authors.initials: LO
authors.lastname: Sjoholm
authors.forename: Jay
authors.initials: J
authors.lastname: Dujon
authors.forename: Abhijit
authors.initials: A
authors.lastname: Pathak
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Santora
authors.forename: Steven R
authors.initials: SR
authors.lastname: Houser
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Goldberg
mesh_terms: D000818:Animals; D001831:Body Temperature / Q000502:physiology; D004195:Disease Models, Animal; D004632:Emergency Medical Services / Q000379:methods; D058734:Exsanguination / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D006439:Hemodynamics / Q000502:physiology; D007442:Intubation, Intratracheal; D011659:Pulmonary Gas Exchange / Q000502:physiology; D012771:Shock, Hemorrhagic / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D013552:Swine; D014950:Wounds, Penetrating / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*