Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-18T20:48:24.808Z Has data issue: false hasContentIssue false
  • English
  • Français

When Pressure is Positive: A Literature Review of the Prehospital Use of Continuous Positive Airway Pressure

Published online by Cambridge University Press:  09 November 2012

Brett Williams ,
Malcolm Boyle ,
Nicole Robertson  and
Coco Giddings
Brett Williams*
Affiliation:
Department of Community Emergency Health and Paramedic Practice, School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University – Peninsula Campus, Frankston, Victoria, Australia
Malcolm Boyle
Affiliation:
Department of Community Emergency Health and Paramedic Practice, School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University – Peninsula Campus, Frankston, Victoria, Australia
Nicole Robertson
Affiliation:
Department of Community Emergency Health and Paramedic Practice, School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University – Peninsula Campus, Frankston, Victoria, Australia
Coco Giddings
Affiliation:
Department of Community Emergency Health and Paramedic Practice, School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University – Peninsula Campus, Frankston, Victoria, Australia
*
Correspondence: Brett Williams, PhD Department of Community Emergency Health and Paramedic Practice Monash University Building H McMahons Road Frankston 3199 Victoria, Australia E-mail [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Heart failure poses a significant burden of disease, resulting in 2,658 Australian deaths in 2008, and listed as an associated cause of death in a further 14,466 cases. Common in the hospital setting, continuous positive airway pressure (CPAP) therapy is a non-invasive ventilation technique used to prevent airway collapse and manage acute pulmonary edema (APO). In the hospital setting, CPAP has been known to decrease the need for endotracheal intubation in patients with APO. Therefore the objective of this literature review was to identify the effectiveness of CPAP therapy in the prehospital environment.

Methods

A review of selected electronic medical databases (Cochrane, Medline, EMBASE, and CINAHL) was conducted from their commencement date through the end of May 2012. Inclusion criterion was any study type reporting the use of CPAP therapy in the prehospital environment, specifically in the treatment of heart failure and acute pulmonary edema. References of relevant articles were also reviewed.

Results

The literature search located 1,253 articles, 12 of which met the inclusion criteria. The majority of studies found that the use of CPAP therapy in the prehospital environment is associated with reduced short-term mortality as well as reduced rates of endotracheal intubation. Continuous positive airway pressure therapy was also shown to improve patient vital signs during prehospital transport and reduce myocardial damage.

Discussion

The studies conducted of prehospital use of CPAP to manage APO have all demonstrated improvement in patient outcomes in the short term.

Conclusion

Available evidence suggests that the use of CPAP therapy in the prehospital environment may be beneficial to patients with acute pulmonary edema as it can potentially decrease the need for endotracheal intubation, improve vital signs during transport to hospital, and improve short-term mortality.

WilliamsB, BoyleM, RobertsonN, GiddingsC. When Pressure is Positive: A Literature Review of the Prehospital Use of Continuous Positive Airway Pressure. Prehosp Disaster Med.2013;28(1):1-10.

Keywords

acute pulmonary edemaCPAPemergency careparamedicprehospital
Type
Comprehensive Review
Information
Prehospital and Disaster Medicine , Volume 28 , Issue 1 , February 2013 , pp. 52 - 60
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.AIHW. Australia's Health 2008. http://www.aihw.gov.au/publications/index.cfm/title/10585. Accessed May 19, 2012.Google Scholar
2.Ambulance Victoria. Performance analysis and data governance. Melbourne: Ambulance Victoria; 2010.Google Scholar
3.Brywczynski, JJ, Barrett, TW, Schriger, DL. Out-of-hospital continuous positive airway pressure ventilation versus usual care in acute respiratory failure: a randomized controlled trial. Answers to the September 2008 Journal Club Questions. Ann Emerg Med. 2009;53(2):272-283.CrossRefGoogle Scholar
4.Kallio, T, Kuisma, M, Alaspaa, A, Rosenberg, PH. The use of prehospital continuous positive airway pressure treatment in presumed acute severe pulmonary edema. Prehosp Emerg Care. 2003;7(2):209-213.CrossRefGoogle ScholarPubMed
5.Thompson, J, Petrie, DA, Ackroyd-Stolarz, S, Bardua, DJ. Out-of-hospital continuous positive airway pressure ventilation versus usual care in acute respiratory failure: A randomized controlled trial. Ann Emerg Med. 2008;52(3):232-241.CrossRefGoogle ScholarPubMed
6.Kosowsky, JM, Stephanides, SL, Branson, RD, Sayre, MR. Prehospital use of continuous positive airway pressure (CPAP) for presumed pulmonary edema: a preliminary case series. Prehosp Emerg Care. 2001;5(2):190-196.CrossRefGoogle ScholarPubMed
7.Dib, J, Matin, S, Luckert, A. Prehospital use of continuous positive airway pressure for acute severe congestive heart failure. J Emerg Med. 2012;42(5):553-558.CrossRefGoogle ScholarPubMed
8.Plaisance, P, Pirracchio, R, Berton, C, Vicaut, E, Payen, D. A randomized study of out-of-hospital continuous positive airway pressure for acute cardiogenic pulmonary oedema: physiological and clinical effects. Eur Heart J. 2007;28(23):2895-2901.CrossRefGoogle ScholarPubMed
9.Ufberg, JW, Bushra, JS, Karras, DJ, Satz, WA, Kueppers, F. Aspiration of gastric contents: association with prehospital intubation. Am J Emerg Med. 2005;23(3):379-382.CrossRefGoogle ScholarPubMed
10.Wang, HE, Sweeney, TA, O'Connor, RE, Rubinstein, H. Failed prehospital intubations: an analysis of emergency department courses and outcomes. Prehosp Emerg Care. 2001;5(2):134-141.CrossRefGoogle ScholarPubMed
11.Hubble, MW, Richards, ME, Jarvis, R, Millikan, T, Young, D. Effectiveness of prehospital continuous positive airway pressure in the management of acute pulmonary edema. Prehosp Emerg Care. 2006;10(4):430-439.CrossRefGoogle ScholarPubMed
12.Fagon, JY, Chastre, J, Domart, Y, Trouillet, JL, Pierre, J, Darne, C, et al. Nosocomial pneumonia in patients receiving continuous mechanical ventilation. Prospective analysis of 52 episodes with use of a protected specimen brush and quantitative culture techniques. Am Rev Respir Dis. 1989;139(4):877-884.CrossRefGoogle ScholarPubMed
13.Torres, A, Aznar, R, Gatell, JM, et al. Incidence, risk, and prognosis factors of nosocomial pneumonia in mechanically ventilated patients. Am Rev Respir Dis. 1990;142(3):523-528.CrossRefGoogle ScholarPubMed
14.NHRMC. NHMRC additional levels of evidence and grades for recommendations for developers of guidelines. 2009. http://www.nhmrc.gov.au/_files_nhmrc/file/guidelines/Stage%202%20Consultation%20Levels%20and%20Grades.pdf. Accessed May 15, 2012.Google Scholar
15.Dieperink, W, Weelink, EEM, Van Der Horst, ICC, et al. Treatment of presumed acute cardiogenic pulmonary oedema in an ambulance system by nurses using Boussignac continuous positive airway pressure. Emerg Med J. 2009;26(2):141-144.CrossRefGoogle Scholar
16.Foti, G, Sangalli, F, Berra, L, et al. Is helmet CPAP first line pre-hospital treatment of presumed severe acute pulmonary edema? Intensive Care Med. 2009;35(4):656-662.CrossRefGoogle ScholarPubMed
17.Gardtman, M, Waagstein, L, Karlsson, T, Herlitz, J. Has an intensified treatment in the ambulance of patients with acute severe left heart failure improved the outcome? Eur J Emerg Med. 2000;7(1):15-24.CrossRefGoogle ScholarPubMed
18.Garuti, G, Bandiera, G, Cattaruzza, MS, et al. Out-of-hospital helmet CPAP in acute respiratory failure reduces mortality: A study led by nurses. Monaldi Archives for Chest Disease - Pulmonary Series. 2010;73(4):145-151.Google ScholarPubMed
19.Templier, F, Dolveck, F, Baer, M, Chauvin, M, Fletcher, D. ‘Boussignac’ continuous positive airway pressure system: practical use in a prehospital medical care unit. Eur J Emerg Med. 2003;10(2):87-93.CrossRefGoogle Scholar
20.Warner, GS. Evaluation of the effect of prehospital application of continuous positive airway pressure therapy in acute respiratory distress. Prehosp Disaster Med. 2010;25(1):87-91.CrossRefGoogle ScholarPubMed
21.Baird, JS, Spiegelman, JB, Prianti, R, Frudak, S, Schleien, CL. Noninvasive ventilation during pediatric interhospital ground transport. Prehosp Emerg Care. 2009;13(2):198-202.CrossRefGoogle ScholarPubMed
22.Bledsoe, BE. Mastering CHF: current strategies for the prehospital care of congestive heart failure. JEMS. 2009;34(2):60-68.Google ScholarPubMed
23.Bledsoe, BE, Bojan, P. Flash pulmonary edema: early recognition & prompt prehospital therapy improve patient outcomes. JEMS. 2004;29(1):54-55.Google ScholarPubMed
24.Bomont, RK, Cheema, IU. Use of nasal continuous positive airway pressure during neonatal transfers. Archives of Disease in Childhood Fetal & Neonatal Edition. 2006;91(2):85-89.CrossRefGoogle ScholarPubMed
25.Bruge, P, Jabre, P, Dru, M, et al. An observational study of noninvasive positive pressure ventilation in an out-of-hospital setting. Am J Emerg Med. 2008;26(2):165-169.CrossRefGoogle Scholar
26.Corey, EC. Improving CHF care. A new algorithm for prehospital treatment. JEMS. 2007;32(4):68-74.CrossRefGoogle Scholar
27.Dominguez, OJ Jr. Breathless. Emerg Med Serv. 2002;31(4):87.Google ScholarPubMed
28.Goss, JF, Zygowiec, J. Positive pressure: CPAP in the treatment of pulmonary edema & COPD. JEMS. 2006;31(11):2-8.CrossRefGoogle ScholarPubMed
29.Hastings, D, Monahan, J, Gray, C, Pavlakovich, D, Bartram, P. CPAP. A supportive adjunct for congestive heart failure in the prehospital setting. JEMS. 1998;23(9):58-65.Google ScholarPubMed
30.Hatlestad, D. Calming the waters: noninvasive positive pressure ventilation in prehospital care. Emerg Med Serv. 2002;31(5):67-71.Google ScholarPubMed
31.Hewitt, MJ, Persse, DE. A CPAP partnership that makes sense. Hospital & EMS systems from a unique agreement. JEMS. 2007;32(10):S20-S21.Google ScholarPubMed
32.Hildwine, F. 10 cm of CPAP in a 10-oz. package. JEMS. 2006;31(6):102-103.CrossRefGoogle Scholar
33.Hubble, MW, Richards, ME, Wilfong, DA. Estimates of cost-effectiveness of prehospital continuous positive airway pressure in the management of acute pulmonary edema. Prehosp Emerg Care. 2008;12(3):277-285.CrossRefGoogle ScholarPubMed
34.Mattu, A, Lawner, B. Prehospital management of congestive heart failure. Heart Fail Clin. 2009;5(1):19-24.CrossRefGoogle ScholarPubMed
35.Oherrick, MR. Prehospital use of continuous positive airway pressure: implications for the emergency department. J Emerg Nurs. 2009;35(4):326-329.CrossRefGoogle ScholarPubMed
36.Schrank, K. Better ventilation. The science to support your CPAP protocol. JEMS. 2007;32(10):S17-S19.Google ScholarPubMed
37.Simpson, PM, Bendall, JC. Prehospital non-invasive ventilation for acute cardiogenic pulmonary oedema: An evidence-based review. Emer Med J. 2011;28(7):609-612.CrossRefGoogle ScholarPubMed
38.Sullivan, R. Prehospital use of CPAP: Positive pressure = positive patient outcomes. Emerg Med Serv. 2005;34(8):120.Google ScholarPubMed
39.Wesley, K. The ‘basic’ skill of CPAP. Adding CPAP to the EMT-B scope of practice. JEMS. 2007;32(10):S21-S22.Google Scholar
40.Younger, CM. Nitro line with CPAP: a new standard of care. JEMS. 2007;32(6):36-37.CrossRefGoogle ScholarPubMed