The pig model of paraoxon poisoning used here exhibited reproducible prolonged respiratory distress and delayed mortality, with signs and symptoms characteristic of organophosphate poisoning [21]. The most important finding in the present study was the dramatic effect of Cuirass technique in reducing the paraoxon-induced mortality (Figure 2). This Cuirass technique was found to be superior to bag-valve mask ventilation, a common

ventilation procedure, expected to be used Sunitinib following both single exposure and on-scene mass casualty event. Earlier studies have demonstrated that respiratory failure was the predominant cause of death in nerve agent poisoning and that significant cardiovascular depression occurred only after cessation of respiration [24] and [25]. This emphasizes the importance of respiratory support over cardiovascular support during early stages following OP poisoning. Biphasic Cuirass Ventilation has been reported as an easily-adopted and rapidly-applied method suitable for use by non-medical personnel, Obeticholic Acid purchase even while wearing protective gear [20]. In addition,

Ben-Abraham et al. [19] have indicated that physicians wearing full personal protective gear applied the cuirass and instituted ventilation faster than performing endotracheal intubation followed by positive pressure ventilation. Unfortunately, as we have shown here for the first time, the bag-valve mask ventilation did not sufficiently improve the impact of OP exposure unless continuously implemented. While animals survived during ventilation, shortly after its termination the animals died and mortality rates resembled that of the non-ventilated Control group. In contrast, ventilation with the cuirass for the same period of time prevented 24 h mortality and the animals recovered better and Vasopressin Receptor faster with no deterioration

following cessation of ventilation. An additional advantage of the Cuirass relates to airway management. In pre-hospital ventilation, a jaw thrust into the BVM is required to avoid the tongue occluding the airway, assuming the supine position of the casualty. This adds to the difficulties of using BVM in the pre-hospital setting of a chemical event. When using the cuirass there is no need for a jaw thrust, as the use of a guedel is enough. In our study there was no need for that since the animals were in a prone position. In recent years several studies described a successful use of supraglottic airways and intubation in the pre-hospital setting [26], [27], [28] and [29]. Endotracheal intubation is still regarded as the golden standard, and supraglottic airways are regarded a bridge until definite airway control is achieved [30]. When looking at the success rates, supraglottic airways are easier to manage, including in a chemical event [26], [27], [28], [29] and [30].