Gur Ilan, Shapira Shlomo, Katalan Shahaf, Rosner Amir, Baranes Shlomo, Grauer Ettie, Moran-Gilad Jacob, Eisenkraft Arik
Bikur Holim Hospital, Jerusalem, Israel.
Israel Institute for Biological Research, Ness-Ziona, Israel.
Toxicol Rep. 2014 Nov 24;2:40-45. doi: 10.1016/j.toxrep.2014.11.001. eCollection 2015.
Exposure to organophosphates (OP) may lead to a life threatening cholinergic crisis with death attributed to a rapidly progressive respiratory failure. In a toxicological mass casualty event involving organophosphate exposure, many of the victims may depend on immediate short-term ventilation to overcome the respiratory distress which may exhaust life supporting resources. In addition, the mandatory use of personal protective gear by first responders emphasizes the need for a noninvasive, easy-to-operate ventilation device. Our objective was to assess the efficacy of MRTX, a Biphasic Cuirass Ventilation device, in comparison with standard bag-valve mask ventilation following acute organophosphate poisoning.
Pigs were exposed to paraoxon poisoning (1.4 LD), and treated 8 min later with atropine (0.05 mg/kg). The control group received no further support ( = 9), the two experimental groups received ventilation support initiated 15 min post exposure and lasted for 25 min: one group was ventilated with the commonly used bag-valve mask (Mask group, = 7) and the other was ventilated with the Biphasic Cuirass Ventilation device (Cuirass group, = 7). Clinical signs and physiological parameters were monitored during the first hour, and mortality up to 24 h post exposure was recorded.
No mortality was observed in the Cuirass group following OP poisoning, while mortality in the Control and in the Mask groups was high (67% and 71%, respectively). Mouth excretions of the cuirass-ventilated animals were frothy white as in deep suctioning, as opposed to the clear saliva-like appearance of secretions in the other two groups. No further group differences were recorded.
The noninvasive, easy-to-operate Biphasic Cuirass Ventilation device was effective in reducing OP-induced mortality and might be advantageous in an organophosphate mass casualty event. This finding should be validated in further investigations.
接触有机磷酸酯（OP）可能导致危及生命的胆碱能危象，死亡原因是快速进展的呼吸衰竭。在涉及有机磷酸酯暴露的毒理学大规模伤亡事件中，许多受害者可能依赖即时的短期通气来克服呼吸窘迫，这可能耗尽生命支持资源。此外，急救人员必须使用个人防护装备，这凸显了对一种无创、易于操作的通气设备的需求。我们的目的是评估双相胸甲通气设备MRTX与急性有机磷酸酯中毒后标准袋阀面罩通气相比的疗效。
猪暴露于对氧磷中毒（1.4倍半数致死剂量），8分钟后用阿托品（0.05毫克/千克）治疗。对照组未接受进一步支持（n = 9），两个实验组在暴露后15分钟开始接受通气支持，持续25分钟：一组用常用的袋阀面罩通气（面罩组，n = 7），另一组用双相胸甲通气设备通气（胸甲组，n = 7）。在最初的一小时内监测临床体征和生理参数，并记录暴露后24小时内的死亡率。
OP中毒后胸甲组未观察到死亡，而对照组和面罩组的死亡率很高（分别为67%和71%）。胸甲通气动物的口腔分泌物呈泡沫状白色，如同深度吸痰时的情况，这与其他两组分泌物清澈似唾液的外观不同。未记录到其他组间差异。
无创、易于操作的双相胸甲通气设备在降低OP诱导的死亡率方面有效，在有机磷酸酯大规模伤亡事件中可能具有优势。这一发现应在进一步研究中得到验证。
