Abstract 10794: Intubation Does Not Result in a Survival Advantage in a Swine Hemorrhagic Shock Model Simulating Penetrating Trauma
Introduction: With new ACLS guidelines prioritizing uninterrupted chest compressions over advanced airway control, the role of pre-hospital intubation in penetrating trauma should be examined. An animal model simulating penetrating trauma was developed to determine if intubation provides a survival advantage during severe hemorrhagic shock.
Hypothesis: 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 lab 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 hemmorhage, temperature, cardiac index, mean arterial pressure (MAP), 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 vs. 48.5±2.4 mins, p=0.52). Intubated animals had greater volume of hemorrhage (see figure) and were more hypothermic at 40 minutes (35.5±0.4 vs. 36.7±0.2 degrees C, p=0.01). In addition, intubated animals had higher lactate levels (2.4±0.1 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.
Conclusion: Intubation does not convey a survival advantage in this model of severe hemorrhagic shock. Furthermore, intubation may result in a more profuse hemorrhage, worse hypothermia, and higher lactate when compared to bag-valve mask ventilation.
- © 2012 by American Heart Association, Inc.