CPAP with suspected acute pulmonary edema in the pre-hospital environment

A study in North Carolina, examining the effectiveness of pre-hospital CPAP in managing acute pulmonary edema in 215 enrolled patients, found that 25.26% of its patients that did not receive CPAP (control group) required intubation, compared to only 8.92% of the group who were administered CPAP (treatment group). This is significant because intubating someone is a very uncomfortable and difficult procedure for the patient and can lead to other complications. The control group had a higher amount of patients intubated in the field, 7.36%, compared to the treatment group, 4.2%, receiving pre-hospital CPAP. Since CPAP is a non-invasive ventilation procedure, it is much easier to get the patient to willingly cooperate and get them on their way to the hospital faster than intubating. Even more importantly, the overall mortality rate of the CPAP group (5.35%) was significantly lower than that of the control group (23.15%).

The effectiveness of CPAP in the pre-hospital environment with the help of transport ventilator was analyzed on the basis of changes in oxygen saturation, the need for tracheal intubation or use of mechanical ventilation, as well as possible complications associated with the use of CPAP-therapy. This was a retrospective cohort study, conducted under the direction of a mobile intensive care unit of the University Hospital. The study included all patients with a clinical picture of the otolith, is being treated at a mobile intensive care unit between January 1, 1998 and December 31, 1999

Acute heart failure syndrome (AHFS) spectrum can be divided into 5 groups as regards therapeutic management:

(i) Dyspnoea + /- congestion with elevated systolic blood pressure (SBP)>140 mmHg, usually with abrupt onset APO (most frequent type)
(ii) Dyspnoea + /- congestion with normal SBP 100-140 mmHg, usually with gradual onset predominant systemic oedema and milder APO
(iii) Dyspnoea + /- congestion with low SBP <100 mmHg, with predominant cardiogenic shock or end-stage cardiac failure (most fatal type)
(iv) Dyspnoea + /- congestion with signs of ACS such as chest pain
(v) Isolated RV failure usually without APO.

Mebazza A, Gheoghiade M, Pina I et al. Practical recommendations for pre- hospital and early in-hospital management of patients presenting with acute heart failure. Crit Care Med 2008;36:S129-39.

Using a continuous positive airway pressure (CPAP) in the treatment of suspected cases of severe acute pulmonary edema in the pre-hospital environment.

PREHOSPITAL EMERGENCY CARE 2003; 7: 209 – 213

Tarja Kallio, MD, Markku Kuisma, MD, Ari Alaspää, MD, Per H. Rosenberg, MD.

Over the past two decades, noninvasive mechanical ventilation and respiratory support with the help of transport ventilator has become an important therapeutic application with the potential to reduce morbidity in acute cardiogenic pulmonary edema. Randomized controlled trials have confirmed the correctness of the use of continuous positive airway pressure (CPAP) in patients with acute severe pulmonary edema (otolith) 1-4 in the hospital environment. This led to a significant reduction in the need for endotracheal intubation (ETI) 1.5 and tended to decrease mortality rate. However, there were obtained the opposite results.

In the pre-hospital environment CPAP with the help of transport ventilator is not used at all or used in rare cases. There are only a few publications on the use of CPAP in heart failure and acute pulmonary edema.

As a whole, it was concluded that earlier and more intensive respiratory support with the help of transport ventilator can lead to a reduction in myocardial injury. In Helsinki for more than 10 years, CPAP has been used as a standard procedure in the treatment of patients at the scene and during transport to the hospital.

Company WestMedGroup Ltd. is the official distributor of systems for oxygen therapy from companies MILS and HVM.