Background: Patients with acute respiratory failure are at risk of deterioration during prehospital transport. Ventilatory\nsupport with continuous positive airway pressure (CPAP) can be initiated in the prehospital setting. The objective of the\nstudy is to evaluate adherence to treatment and effectiveness of CPAP as an addition to standard care.\nMethods: In North Denmark Region, patients with acute respiratory failure, whom paramedics assessed as suffering\nfrom acute cardiopulmonary oedema, acute exacerbation of chronic obstructive pulmonary disease or asthma were\ntreated with CPAP using 100 % O2 from 1 March 2014 to 3 May 2015. Adherence to treatment was evaluated by\nnumber of adverse events and discontinuation of treatment. Intensive care admissions and mortality were reported in\nthis cohort. Effectiveness was evaluated by changes in peripheral oxygen saturation (SpO2) and respiratory rate during\ntransport and compared to a historical control (non-CPAP) group treated with standard care only. Values were\ncompared by hypothesis testing and linear modelling of SpO2 on arrival at scene and Ã?â?SpO2 stratified according to\ntreatment group.\nResults: In fourteen months, 171 patients were treated with CPAP (mean treatment time 35 Ã?± 18 min). Adverse events\nwere reported in 15 patients (9 %), hereof six discontinued CPAP due to hypotension, nausea or worsening dyspnoea.\nOne serious adverse event was reported, a suspected pneumothorax treated adequately by an anaesthesiologist called\nfrom a mobile emergency care unit. Among CPAP patients, 45 (27 %) were admitted to an intensive care unit and 24\n(14 %) died before hospital discharge. The non-CPAP group consisted of 739 patients. From arrival at scene to arrival at\nhospital, CPAP patients had a larger increase in SpO2 than non-CPAP patients (87 to 96 % versus 92 to 96 %, p < 0.01)\nand a larger decrease in respiratory rate (32 to 25 versus 28 to 24 breaths/min, p < 0.01). In a linear model, CPAP was\nsuperior to non-CPAP in patients with initial SpO2 ââ?°Â¤90 % (p < 0.05). One CPAP patient (0.6 %) and eight non-CPAP\npatients (1.1 %) were intubated in the prehospital setting.\nDiscussion: The study design reflects the daily prehospital working environment including long transport timesand\nparamedics educated in treating symptoms of acute respiratory failure, rather than treating one specific diagnosis. The\nstudy population was included consecutively and few patients were lost to follow-up. However, the study was too\nsmall to allow assessment of any effect of prehospital CPAP on mortality, nor could the effectiveness in specific disease\nconditions be examined.
Loading....