TY - JOUR
T1 - Prehospital continuous positive airway pressure (CPAP) for acute respiratory distress
T2 - A randomised controlled trial
AU - Finn, Judith C.
AU - Brink, Deon
AU - McKenzie, Nicole
AU - Garcia, Antony
AU - Tohira, Hideo
AU - Perkins, Gavin D.
AU - Arendts, Glenn
AU - Fatovich, Daniel M.
AU - Hendrie, Delia
AU - McQuillan, Brendan
AU - Summers, Quentin
AU - Celenza, Antonio
AU - Mukherjee, Ashes
AU - Smedley, Ben
AU - Pereira, Gavin
AU - Ball, Stephen
AU - Williams, Teresa
AU - Bailey, Paul
PY - 2022/1
Y1 - 2022/1
N2 - Objective: To compare the efficacy of continuous positive airway pressure (CPAP) versus usual care for prehospital patients with severe respiratory distress. Methods: We conducted a parallel group, individual patient, non-blinded randomised controlled trial in Western Australia between March 2016 and December 2018. Eligible patients were aged ≥40 years with acute severe respiratory distress of non-traumatic origin and unresponsive to initial treatments by emergency medical service (EMS) paramedics. Patients were randomised (1:1) to usual care or usual care plus CPAP. The primary outcomes were change in dyspnoea score and change in RR at ED arrival, and hospital length of stay. Results: 708 patients were randomly assigned (opaque sealed envelope) to usual care (n=346) or CPAP (n=362). Compared with usual care, patients randomised to CPAP had a greater reduction in dyspnoea scores (usual care -1.0, IQR -3.0 to 0.0 vs CPAP -3.5, IQR -5.2 to -2.0), median difference -2.0 (95% CI -2.5 to -1.6); and RR (usual care -4.0, IQR -9.0 to 0.0 min-1 vs CPAP -8.0, IQR -14.0 to -4.0 min-1), median difference -4.0 (95% CI -5.0 to -4.0) min-1. There was no difference in hospital length of stay (usual care 4.2, IQR 2.1 to 7.8 days vs CPAP 4.8, IQR 2.5 to 7.9 days) for the n=624 cases admitted to hospital, median difference 0.36 (95% CI -0.17 to 0.90). Conclusions: The use of prehospital CPAP by EMS paramedics reduced dyspnoea and tachypnoea in patients with acute respiratory distress but did not impact hospital length of stay. Trial registration number: ACTRN12615001180505.
AB - Objective: To compare the efficacy of continuous positive airway pressure (CPAP) versus usual care for prehospital patients with severe respiratory distress. Methods: We conducted a parallel group, individual patient, non-blinded randomised controlled trial in Western Australia between March 2016 and December 2018. Eligible patients were aged ≥40 years with acute severe respiratory distress of non-traumatic origin and unresponsive to initial treatments by emergency medical service (EMS) paramedics. Patients were randomised (1:1) to usual care or usual care plus CPAP. The primary outcomes were change in dyspnoea score and change in RR at ED arrival, and hospital length of stay. Results: 708 patients were randomly assigned (opaque sealed envelope) to usual care (n=346) or CPAP (n=362). Compared with usual care, patients randomised to CPAP had a greater reduction in dyspnoea scores (usual care -1.0, IQR -3.0 to 0.0 vs CPAP -3.5, IQR -5.2 to -2.0), median difference -2.0 (95% CI -2.5 to -1.6); and RR (usual care -4.0, IQR -9.0 to 0.0 min-1 vs CPAP -8.0, IQR -14.0 to -4.0 min-1), median difference -4.0 (95% CI -5.0 to -4.0) min-1. There was no difference in hospital length of stay (usual care 4.2, IQR 2.1 to 7.8 days vs CPAP 4.8, IQR 2.5 to 7.9 days) for the n=624 cases admitted to hospital, median difference 0.36 (95% CI -0.17 to 0.90). Conclusions: The use of prehospital CPAP by EMS paramedics reduced dyspnoea and tachypnoea in patients with acute respiratory distress but did not impact hospital length of stay. Trial registration number: ACTRN12615001180505.
KW - clinical management
KW - COPD
KW - non invasive
KW - prehospital care
KW - respiratory
KW - ventilation
UR - http://www.scopus.com/inward/record.url?scp=85103451832&partnerID=8YFLogxK
U2 - 10.1136/emermed-2020-210256
DO - 10.1136/emermed-2020-210256
M3 - Article
C2 - 33771819
AN - SCOPUS:85103451832
SN - 1472-0205
VL - 39
SP - 37
EP - 44
JO - Emergency Medicine Journal
JF - Emergency Medicine Journal
IS - 1
ER -