Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania 19140, USA.
J Trauma Acute Care Surg. 2013 May;74(5):1246-51. doi: 10.1097/TA.0b013e31828dab10.
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.
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.
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.
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.
在经历穿透性创伤的患者中，院前插管并没有带来生存优势，但仍存在对立即转运以获得确定性治疗的抵制。我们开发了一种动物模型，以确定插管在严重出血性休克期间是否具有生存优势。我们假设插管在潜在致命性出血中不会提供生存优势。
在开始异丙酚滴注后，对约克夏猪进行插管（n = 6）或使用 100%氧气进行球囊面罩通气（n = 7）。通过 14 号导管对颈总动脉进行插管，并在透视引导下使用中心静脉导入器放置 Swan-Ganz 导管。在获得基线血流动力学和实验室数据后，通过颈动脉线将动物放血直至死亡。主要终点是死亡时间，次要终点包括失血量、体温、心指数、平均动脉压、乳酸、碱剩余和每隔 10 分钟测量的肌酐水平。
两组之间的死亡时间无差异（51.1 [2.5] 分钟 vs. 48.5 [2.4] 分钟，p = 0.52）。插管动物在 30 分钟时失血量更大（33.6 [4.4] mL/kg vs. 28.5 [4.3] mL/kg，p = 0.03）、40 分钟时失血量更大（41.7 [4.7] mL/kg vs. 34.9 [3.8] mL/kg，p = 0.04）和 50 分钟时失血量更大（49.2 [8.6] mL/kg vs. 40.2 [1.0] mL/kg，p = 0.001）。此外，插管动物在 40 分钟时体温更低（35.5°C [0.4°C] vs. 36.7°C [0.2°C]，p = 0.01），并且在 10 分钟时乳酸水平更高（2.4 [0.1] mmol/L vs. 1.8 [0.4] mmol/L，p = 0.04）。心指数（p = 0.66）、平均动脉压（p = 0.69）、碱剩余（p = 0.14）和肌酐水平（p = 0.37）在整个休克阶段均无差异。
在这种严重出血性休克模型中，插管没有带来生存优势。此外，与球囊面罩通气相比，严重出血性休克时的插管可能导致更多的出血、更严重的低体温和更高的乳酸水平。
