Exclusives
FacebookTwitterLinkedInGoogle+RSS Feed
Fire EMSEMS TodayEMS Insider

Effectiveness of Prehospital CPAP in Managing Acute Pulmonary Edema

Review of: Michael H, Michael R, Roger J, et al: "Effectiveness of prehospital continuous positive airway pressure in the management of acute pulmonary edema." Prehospital Emergency Care. 10(4):430-439, 2006

The Science

This non-randomized control group study compared the outcomes of patients in respiratory distress from presumed pulmonary edema treated by two county-based ALS EMS systems in North Carolina. One service (control group) treated the patients with furosemide, morphine, and nitroglycerin (standard therapy) and the other service (treatment group) provided non-invasive continuous positive airway pressure (CPAP) in conjunction with standard therapy. The primary outcomes were intubation rates, mortality, and the length of stay in the hospital.

Of the 215 patients enrolled, 55.8% received CPAP. From the control group, 25.26% required intubation, compared to only 8.92% from the treatment group. The percentage of patients intubated in the field was 7.36% for the control group and 4.2% for the treatment group. The overall mortality rate was 5.35% in the CPAP group, which was significantly lower than the 23.15% rate observed in the control group (p=0.000). While length of stay was on average two days shorter for the treatment group, the difference did not meet statistical significance due to low patient numbers.

The Street

This study is consistent with a growing body of research that supports the use of CPAP for respiratory distress. While this study was designed to specifically address the value of CPAP for the treatment of acute pulmonary edema, further investigation by the authors discovered that almost 25% did not have acute pulmonary edema as their final hospital diagnosis. The most common underlying conditions misdiagnosed by EMS as pulmonary edema were COPD and pneumonia. We have all been misled by our assessment and heard rales, when in fact the patient had crackles, wheezes, and rhonchi.

Another interesting thing in this study is that the CPAP patients appear to have been sicker as demonstrated by higher respiratory rates, blood pressures, and subjective complaints of dsypnea. Another difference between the two groups was that the control group was significantly more likely to receive furosemide and morphine, while the CPAP group received significantly greater doses of nitro.

Despite these dissimilarities and the inclusion of CPAP use in patients not in acute pulmonary edema, the CPAP patients still did better in all three outcomes compared to standard therapy.

Though not statistically significant due to low numbers, the patients in the control group who were placed on CPAP after hospitalization also had a lower mortality rate and need for intubation when compared to those who did not receive CPAP.

CPAP lessens the work of breathing in patients in respiratory distress from all causes and results in fewer intubations and lower mortality. This has huge ramifications on healthcare costs, as those not intubated are less likely to require ICU admission. Prehospital CPAP reduces the need for intubation and places the patient into the continuum of care that can be continued after admission. The role of furosemide and morphine has been previously evaluated with some studies showing that the inappropriate administration of these drugs to patients who don t have pulmonary edema increases their length of stay and mortality rates.

Bottom line? CPAP for everyone!

RELATED ARTICLES

Take Back Control of Your Patient Care Reporting and Data Management Process

Imagine your crew members effortlessly completing patient care reports – and all of the mandatory data your organization requires to be sure those PCRs are a...

Staying Composed Among the Chaos of 'Meeting the Mexican Ambulance'

What do you do when you're given a patient with no information?

Montgomery County (Texas) Hospital District's Community Paramedicine Program Sees Early Success

We have accountability and responsibility for all aspects of patient care.

A Review of Education Deficiencies and Ways to Improve the Care of Pediatric Patients

How can we improve proficiency in pediatric patient care?

Australia's Royal Flying Doctor Service is the World's Largest Aeromedical Response Service

Providing effective aeromedical retrieval across 2.76 million square miles.

Tranexamic Acid's Potentially Bright Future Relies on Collaborative Data

EMS agencies using tranexamic acid (TXA) believe that TXA can improve survival as a part of an organized trauma system.

Features by Topic

JEMS Connect

CURRENT DISCUSSIONS

 
 

EMS BLOGS

Blogger Browser

Today's Featured Posts

Featured Careers