Biphasic extrathoracic cuirass ventilation for resuscitation Ilan Gur MD a , Ephraim Bar-Yishay PhD b , Ron Ben-Abraham MD, DEA, MHA c, * a Neonatal Intensive Care Unit, Bikur Holim Hospital, Jerusalem, Israel b Pulmonary Function Laboratory, Hadassah University Hospital, Jerusalem, the Hadassah Faculty of Medicine, Hebrew University, Jerusalem, Israel c Department of Anesthesiology and Critical Care Medicine, Tel-Aviv Sourasky Medical Center, the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Received 13 October 2004; accepted 24 October 2004 Abstract Purposes: The MRTX portable lightweight respirator (MRTX) provides noninvasive respiratory support using biphasic extrathoracic ventilation via a cuirass fitted around the patient’s chest. Methods: MRTX was applied with or without full protective gear, on adult volunteers simulating nerve agent (NA) victims by nonmedical caregivers. Assessment was made based on scores for correct positioning of the cuirass, quality of seal, and rapid ness. Results: For the unprotected and protected personnel, the respective median (F95% confidence interval) scores for correct positioning of the cuirass were 2 (1.4-1.9) and 1 (1.2-1.8) (n = 15 per group, P = NS); quality of seal scores were 2 (1.5-2.0) and 2 (1.3-1.8) ( P = NS); and mean (FSD) time required for instituting mechanical ventilation was 90.5 F 10.9 and 100.3 F 7.9 seconds ( P b .05). The respirator was activated at first attempt 11 times in the group of 15 without protective gear and 8 times in the group of 15 with protective gear ( P = NS). Discussion: Biphasic cuirass ventilation is an easily learned and rapidly applied method suitable for use by nonmedical personnel, even when wearing cumbersome protective gear. D 2005 Elsevier Inc. All rights reserved. 1. Introduction Chemical warfare using nerve agents (NA) can cause high mortality rates, as demonstrated in the terrorist attacks against urban populations in Japan in 1994 and 1995 and in the military use of NA by Iraq against Iran and the Iraqi Kurdish population during the 1980s. The high toxicity of NA derives from their powerful ability to irreversibly inhibit acetylcholinesterase, which regulates the activity of both the nicotinic and muscarinic synapses. The resultant accumulation of acetylcholine at the neuro-effector junc- tions leads to disruption of normal synaptic transmission in both the peripheral and central cholinergic systems, leading to the clinical manifestations of severe cholinergic crisis [1]. The immediate cause of death is usually rapid progressive respiratory failure brought about by NA’s poisonous and depressive action on the central respiratory center and on the neuromuscular junction and airways. 0735-6757/$ – see front matter D 2005 Elsevier Inc. All rights reserved. doi:10.1016/j.ajem.2004.10.004 T Corresponding author. E-mail address: rba1@netvision.net.il (R. Ben-Abraham). American Journal of Emergency Medicine (2005) 23, 488–491 www.elsevier.com/locate/ajem