Is helmet CPAP first line pre-hospital treatment of presumed severe acute pulmonary edema?

Abstract

PURPOSE: Non invasive Continuous Positive Airway Pressure (CPAP) is effective in reducingintubation rate and mortality of patient with Acute Cardiogenic Pulmonary Edema (ACPE). We report our experience on pre-hospital application of CPAP by helmet as an adjunct to medical therapy or as a stand alone procedure in patient with presumed ACPE. METHODS: In pre-hospital treatment of 62 patients with presumed ACPE, CPAP was added to standard medical treatment while in another 59 patients, CPAP was used as a sole therapy . RESULTS: Helmet CPAP was feasible in all patients. No patient required pre-hospital intubation. In both groups, CPAP significantly improved oxygenation (SpO 2 went from 79 ± 12 % to 97 ± 3% and from 81 ± 13 % to 98 ± 3 %), reduced respiratory rate (from 26 ± 4 to 21 ± 3 bpm and from 30 ± 9 to 22 ± 8 bpm) and improved hemodynamics, with a more pronounced decrease in blood pressure in the group with medical treatment than in the one without it. In the two cohorts, four and five patients were respectively intubated in Emergency Department and eleven and nine eventually died. CONCLUSIONS:Helmet CPAP is feasible, efficient and safe in pre-hospital treatment of presumed ACPE. A significant improvement of physiological variables was observed also in the group treated with CPAP in absence of a drug therapy. We propose helmet CPAP as first line prehospital treatment of presumed severe ACPE.

Pre-hospital non-invasive ventilation for acute respiratory failure: a systematic review and cost-effectiveness evaluation

“…Non-randomised observational studies without a control group Twelve studies [61][62][63][68][69][70][71]73,75,76,78,79 described the use of pre-hospital NIV in patients with acute respiratory failure. A summary of the studies is presented in Table 14.…”

“…A summary of the studies is presented in Table 14. Studies were published between 2000 and 2013, and were undertaken in Finland, 75 France, 61,63,78 Greece, 71,73 Italy, 69 the Netherlands, 68 Portugal, 70 and the USA. 62,76,79 Two studies 61,75 collected data retrospectively, while the remaining studies used a prospective study design.…”

“…62,76,79 Two studies 61,75 collected data retrospectively, while the remaining studies used a prospective study design. 62,63,[68][69][70][71]73,76,78,79 While all studies included patients with acute respiratory distress, there was wide variation in terms of underlying conditions resulting in respiratory failure. The sample sizes of the studies ranged between 19 patients 76 to 340 patients, 62 with the mean age of participants ranging from 67.7 years 62 to 78.3 years 69 (no details of mean age were provided in four studies).…”

“…62,63,[68][69][70][71]73,76,78,79 While all studies included patients with acute respiratory distress, there was wide variation in terms of underlying conditions resulting in respiratory failure. The sample sizes of the studies ranged between 19 patients 76 to 340 patients, 62 with the mean age of participants ranging from 67.7 years 62 to 78.3 years 69 (no details of mean age were provided in four studies). 68,73,75,79 , In one study, 61 the mean age of patients was reported separately by underlying condition (asthma, 48 years and COPD, 68 years)…”

“…Although four studies 61,70,71,79 did not provide details relating to the CPAP interface, six studies used a face mask 62,68,73,75,76,78 and one used a helmet 69 as the interface of choice for the administration of CPAP. NIV was administered by paramedics in two studies, 62,76 physicians in four studies, 71,73,75,78 an ambulance nurse in one study, 68 a physician or nurse in one study, 69 and an emergency service team in one study. 79 Three studies 61,63,70 provided no information on the category of medical personnel that administered pre-hospital NIV.…”