Prehospital use of continuous positive airway pressure (CPAP) for presumed pulmonary edema: a preliminary case series

Prehospital Emergency Care : Official Journal of the National Association of EMS Physicians and the National Association of State EMS Directors
J M KosowskyM R Sayre

Abstract

To describe the prehospital use of a continuous positive airway pressure (CPAP) system for the treatment of acute respiratory failure presumed to be due to cardiogenic pulmonary edema. Prospective case-series analysis. Paramedics administered CPAP via face mask at 10 cm H2O to patients believed to be in cardiogenic pulmonary edema and in imminent need of endotracheal intubation (ETI). Data from run sheets and hospital records were analyzed for treatment intervals, vital signs, complications, admitting diagnoses, need for ETI, and mortality. Nineteen patients received prehospital CPAP therapy. Mean duration of therapy was 15.5 minutes. Pre- and post-therapy pulse oximetry was available for 15 patients and demonstrated an increase from a mean of 83.3% to a mean of 95.4%. None of the patients were intubated in the field. Two patients who did not tolerate the CPAP mask required ETI upon arrival in the emergency department (ED); an additional five patients required ETI within 24 hours. There was one death in the series and two additional adverse events (one aspiration pneumonia, one pneumothorax); none of these were attributable to the use of CPAP. The diagnosis of cardiogenic pulmonary edema was corroborated by the ED or in-hospita...Continue Reading

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Citations

Apr 25, 2003·Prehospital Emergency Care : Official Journal of the National Association of EMS Physicians and the National Association of State EMS Directors·Tarja KallioPer H Rosenberg
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