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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]
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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

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