Date of Presentation: May 17, 2023
Dr. Steve Mitchell, MD, FACEP from the University of Washington had a major podium presentation at the Society of Academic Emergency Medicine Meeting in Austin Texas. Below is the abstract of the presentation:
Apneic oxygenation techniques have yielded mixed results in extending the safe apnea period (SAP) and preventing severe hypoxemia during rapid sequence intubation (RSI). We hypothesized that using an endotracheal tube cap device, Turbo® O₂ (TO2), which delivers 15 liters per minute (LPM) of oxygen (O₂) through the endotracheal tube (ETT) tip during RSI in a porcine model, would yield a prolonged safe apnea period.
We used 6 Yorkshire pigs between 75-85 kg utilizing Good Laboratory Practice. Each pig underwent 2 controls and 2 test cycles. Each cycle consisted of paralysis with succinylcholine (sux) followed by placement of an ETT in the glottis 1-2 cm above the vocal cords simulating a prolonged intubation attempt. The control cycle utilized a standard ETT while each test cycle utilized an ETT with an attached TO2 cap. We then measured SpO2, pO2, pCO2, and pH at baseline and 1-minute (min) intervals to 10 min, then every 2 min to 16 min which concluded the cycle. SpO2 was tracked until reaching 75%- or 16-min post sux; whichever came first.
SpO2 was maintained at ≥ 97% (mean 99.81, SD 0.45) for the entirety of each 16-minute test cycle whereas each control cycle resulted in desaturation to 75% (end of cycle) within 56 seconds (mean 47.1 seconds, SD 5.58 seconds). In the test cycles the pO2 increased from a baseline mean of 150.58 mmHg (SD 34.39 mmHg) to an end cycle mean of 208.25 mmHg (SD 24.15 mmHg) (p <0.05). The pCO2 increased from a baseline mean of 44 mmHg (SD 8.58 mmHg) to an end-of-cycle mean of 88.5 mmHg (SD 20.78 mmHg) and the pH decreased from a baseline mean of 7.48 (SD 0.079) to an end of cycle mean of 7.23 (SD 0.092) as anticipated with apnea (p < 0.05).
In this simulation of a prolonged intubation attempt in a porcine RSI model, using an ETT with an attached TO2 cap provides an SAP of > 16 mins with SpO2 and pO2 maintained at safe levels and pH and pCO2 changing at anticipated rates from RSI-induced apnea. Using an ETT with an attached TO2 cap may prolong SAP in humans undergoing RSI and requires further evaluation to determine safety and benefit as an adjunct for apneic oxygenation.