T He Prehospital Administration of Intravenous Methylprednisolone Lowers Hospital Admission Rates for Moderate to Severe Asthma

Knapp, Barry; Wood, C. B.

doi:10.1080/312703002119

Cited by 22 publications

(21 citation statements)

References 4 publications

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“…In an attempt to explore whether the effect of systemic steroids extended to the prehospital arena, Knapp et al published a retrospective case review comparing admission rates in patients with moderate to severe asthma exacerbations who received 125 mg IV methylprednisolone via EMS compared to in the ED. 26 They found that patients who received steroids via EMS had a lower admission rate (13% compared to 33%) and had a quicker resolution of symptoms (15 +/− 7 minutes compared to 40 +/− 22 minutes).…”

Section: Resultsmentioning

confidence: 99%

Adult Patients with Respiratory Distress: Current Evidence-based Recommendations for Prehospital Care

Hodroge

Glenn

Breyre

et al. 2020

WestJEM

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Introduction We developed evidence-based recommendations for prehospital evaluation and treatment of adult patients with respiratory distress. These recommendations are compared with current protocols used by the 33 local emergency medical services agencies (LEMSA) in California. Methods We performed a review of the evidence in the prehospital treatment of adult patients with respiratory distress. The quality of evidence was rated and used to form guidelines. We then compared the respiratory distress protocols of each of the 33 LEMSAs for consistency with these recommendations. Results PICO (population/problem, intervention, control group, outcome) questions investigated were treatment with oxygen, albuterol, ipratropium, steroids, nitroglycerin, furosemide, and non-invasive ventilation. Literature review revealed that oxygen titration to no more than 94–96% for most acutely ill medical patients and to 88–92% in patients with acute chronic obstructive pulmonary disease (COPD) exacerbation is associated with decreased mortality. In patients with bronchospastic disease, the data shows improved symptoms and peak flow rates after the administration of albuterol. There is limited data regarding prehospital use of ipratropium, and the benefit is less clear. The literature supports the use of systemic steroids in those with asthma and COPD to improve symptoms and decrease hospital admissions. There is weak evidence to support the use of nitrates in critically ill, hypertensive patients with acute pulmonary edema (APE) and moderate evidence that furosemide may be harmful if administered prehospital to patients with suspected APE. Non-invasive positive pressure ventilation (NIPPV) is shown in the literature to be safe and effective in the treatment of respiratory distress due to acute pulmonary edema, bronchospasm, and other conditions. It decreases both mortality and the need for intubation. Albuterol, nitroglycerin, and NIPPV were found in the protocols of every LEMSA. Ipratropium, furosemide, and oxygen titration were found in a proportion of the protocols, and steroids were not prescribed in any LEMSA protocol. Conclusion Prehospital treatment of adult patients with respiratory distress varies widely across California. We present evidence-based recommendations for the prehospital treatment of undifferentiated adult patients with respiratory distress that will assist with standardizing management and may be useful for EMS medical directors when creating and revising protocols.

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Section: Resultsmentioning

confidence: 99%

Adult Patients with Respiratory Distress: Current Evidence-based Recommendations for Prehospital Care

Hodroge

Glenn

Breyre

et al. 2020

WestJEM

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“…It is important to note that the study quality of one 19 is poor and the inferences are probably hypothesis generating at best. The second, 20 whilst better in quality, provides weak evidence of an effect. Randomised controlled trials and subsequent meta-analysis does however provide strong evidence of benefit, at least in an ED setting.…”

Section: Discussionmentioning

confidence: 95%

“…Of these four articles, only two were comparative studies. [19][20] These two comparative studies were critically appraised by two reviewers (DL, JB). This low number was not unexpected due to the dearth of out-of-hospital research.…”

Section: Out-of-hospital Literature Reviewmentioning

confidence: 99%

“…The authors remarked that 105 patients would have been required in the steroid group (versus 11) to make the differences observed significant. Knapp & Wood (2003) 20 conducted a retrospective comparative study of patients aged 18 to 50 in an urban setting of Virginia, United States. Patients with moderate to severe asthma received either 125 mg methylprednisolone (Solu-Medrol) i.v.…”

Section: Out-of-hospital Literature Reviewmentioning

confidence: 99%

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Out-of-Hospital Administration of Corticosteroids to Patients with Acute Asthma: A Case Study and Literature Review

Long

Bendall

Bower

2008

Australasian Journal of Paramedicine

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Introduction Asthma is an important health problem in Australia with more than 2.2. million Australians currently diagnosed with Asthma. Asthma is associated with significant mortality and frequent use of emergency medical services. The objectives of this paper were to: a) present a case study of a near-fatal episode of severe acute asthma in which the patient was administered corticosteroids by an Ambulance Service of New South Wales Extended Care Paramedic; b) review the epidemiology and pathophysiology of acute asthma as well as current pharmacotherapy in asthma management; and c) conduct a literature search and critical appraisal of existing evidence supporting the out-of-hospital administration of corticosteroids for acute asthma by paramedics. Methods The purpose of the literature search was to identify comparative studies of adult patients with “acute” asthma treated by paramedics with corticosteroids prior to arrival at the emergency department (ED) to evaluate whether this intervention is associated with improved outcomes. A literature search of databases included the Cochrane Database of Systematic Reviews (Cochrane Reviews Issue 4 2008), Cochrane Central Register of Controlled Trials (Clinical Trials), Medline (1950- November 2008), EMBASE and CINAHL. A pre-hospital filter was applied to increase the sensitivity of the searches as appropriate. MeSH headings included exp/asthma, exp/hydrocortisone, exp/prednisone, exp/prednisolone and exp/glucocorticoids. Searched text words included asthma, hydrocortisone, prednisone and prednisolone. Titles and abstracts of interest were inspected to identify relevant articles with the full text of selected articles retrieved. Identified papers were independently appraised by two reviewers. Results Only two original studies were identified. The first was a retrospective comparative study of adult patients with moderate to severe asthma who received 125 mg methylprednisolone prior to transport to hospital or after arrival in the ED. The second study was a retrospective chart review to determine whether the out-of-hospital administration of systemic steroids to asthmatic patients had any effect on hospital admission rates. Conclusion Corticosteroids have been widely used in the hospital setting for many years in the treatment of acute asthma and there is good evidence to support their early administration in an ED setting. Out-of-hospital studies provide only weak evidence of benefit. There is insufficient evidence of adequate quality to determine if corticosteroids should be routinely used by paramedics. A prospective randomised controlled trial is needed to determine the true value of early corticosteroid administration in the ambulance setting.

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“…62,63 Preliminary evidence now suggests a decreased odds of admission for the moderate-to-severe asthmatic patient who receives very early prehospital (vs. in-hospital) corticosteroid administration. 64 After extensive discussion, however, the group concluded the evidence for prehospital steroids to be of insufficient strength to include this treatment in the model. Therefore, the critical therapy of choice, by either EMT-basics or paramedics, remains the beta-agonist intervention.…”

Section: Bronchospasmmentioning

confidence: 97%

Evidence-Based Performance Measures for Emergency Medical Services Systems: A Model for Expanded EMS Benchmarking

Myers

Slovis

Eckstein

et al. 2008

Prehospital Emergency Care

105

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There are few evidence-based measures of emergency medical services (EMS) system performance. In many jurisdictions, response-time intervals for advanced life support units and resuscitation rates for victims of cardiac arrest are the primary measures of EMS system performance. The association of the former with patient outcomes is not supported explicitly by the medical literature, while the latter focuses on a very small proportion of the EMS patient population and thus does not represent a sufficiently broad selection of patients. While these metrics have their place in performance measurement, a more robust method to measure and benchmark EMS performance is needed. The 2007 U.S. Metropolitan Municipalities' EMS Medical Directors' Consortium has developed the following model that encompasses a broader range of clinical situations, including myocardial infarction, pulmonary edema, bronchospasm, status epilepticus, and trauma. Where possible, the benefit conferred by EMS interventions is presented in the number needed to treat format. It is hoped that utilization of this model will serve to improve EMS system design and deployment strategies while enhancing the benchmarking and sharing of best practices among EMS systems.

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T He Prehospital Administration of Intravenous Methylprednisolone Lowers Hospital Admission Rates for Moderate to Severe Asthma

Abstract: Patients with moderate to severe asthma who receive intravenous methylprednisolone in the prehospital setting have significantly fewer hospital admissions.

Cited by 22 publications

References 4 publications

Adult Patients with Respiratory Distress: Current Evidence-based Recommendations for Prehospital Care

Adult Patients with Respiratory Distress: Current Evidence-based Recommendations for Prehospital Care

Out-of-Hospital Administration of Corticosteroids to Patients with Acute Asthma: A Case Study and Literature Review

Evidence-Based Performance Measures for Emergency Medical Services Systems: A Model for Expanded EMS Benchmarking

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