• J Emerg Med · Aug 2013

    Assessment of the addition of prehospital continuous positive airway pressure (CPAP) to an urban emergency medical services (EMS) system in persons with severe respiratory distress.

    • James V Dunford, Ekta Patel, Steve A Aguilar, Edward Castillo, Bryan Lam, Jennifer Choy, and John Pringle.
    • Department of Emergency Medicine, University of California San Diego Medical Center, San Diego, California 92103-8819, USA.
    • J Emerg Med. 2013 Aug 1;45(2):210-9.

    BackgroundThe use of continuous positive airway pressure (CPAP) assisted ventilation in the emergency department(ED) has been well described.ObjectivesThe purpose of this study was to measure the efficacy of adding pre-hospital CPAP to an urban emergency medical service (EMS) respiratory distress protocol on persons with respiratory distress.MethodsA historical cohort analysis of consecutive patients between 2005 and 2010. Groups were matched for severity of respiratory distress. Physiologic variables were the primary outcome obtained from first responders and upon triage in the ED. Additional outcomes included endotracheal intubation rate, hospital mortality, overall hospital length of stay(LOS), intensive care unit (ICU) admission, and ICU length of stay (ICU LOS).ResultsThere were 410 consecutive patients with predetermined criteria for severe respiratory distress, 235 historical controls matched with 175 post-implementation patients. Average age was 67 years, 54% being male. There were significant median differences in heart and respiratory rates favoring the historical cohort (p < 0.05). There were no significant differences in intubation rate, overall hospital LOS, ICU admission rate, ICU LOS, and hospital mortality (p > 0.05).Patients that were continued on noninvasive ventilatory assistance had a significantly improved rate of intubation and ICU LOS (p < 0.05).ConclusionsThe addition of CPAP to our pre-hospital respiratory distress protocol did not improve physiologic variables.There were no differences in overall and ICU LOS between groups. Persons with apparent continued ventilatory assistance appeared to have improved rates of intubation and ICU LOS [corrected].Copyright © 2013 Elsevier Inc. All rights reserved.

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