Annals of Emergency Medicine
Volume 52, Issue 3 , Pages 232-241.e1 , September 2008

Out-of-Hospital Continuous Positive Airway Pressure Ventilation Versus Usual Care in Acute Respiratory Failure: A Randomized Controlled Trial

Presented at the International Congress of Emergency Medicine, June 2006, Halifax, Nova Scotia, Canada.

  • James Thompson, MD, FRCPC

      Affiliations

    • Department of Emergency Medicine, St. Paul's Hospital, Vancouver, British Columbia, Canada
  • ,
  • David A. Petrie, MD, FRCPC

      Affiliations

    • Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
    • Corresponding Author InformationAddress for correspondence: David A. Petrie, MD, FRCPC, Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada B3H 2Y9; 902-473-8959, fax 902-494-1625
  • ,
  • Stacy Ackroyd-Stolarz, PhD (C)

      Affiliations

    • Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
  • ,
  • Darrell J. Bardua, ACP

      Affiliations

    • Emergency Health Services, Dartmouth, Nova Scotia, Canada

Received 6 February 2007 ,Revised 18 October 2007 ,Accepted 9 January 2008.

References 

  1. Maio RF, Garrison HG, Spaite DW, et al. Emergency medical services outcomes project I (EMSOP I): prioritizing conditions for outcomes research. Ann Emerg Med. 1999;33:423–432
  2. Wang HE, Yealy DM. Out-of-hospital endotracheal intubation: where are we?. Ann Emerg Med. 2006;47:532–541
  3. Ufberg JW, Bushra JS, Karras DJ, et al. Aspiration of gastric contents: association with prehospital intubation. Am J Emerg Med. 2005;23:379–382
  4. Wang HE, Sweeney TA, O'Connor RE, et al. Failed prehospital intubations: an analysis of emergency department courses and outcomes. Prehosp Emerg Care. 2001;5:134–141
  5. Fagon JY, Chastre J, Domart Y, et al. Nosocomial pneumonia in patients receiving continuous mechanical ventilation (Prospective analysis of 52 episodes with use of a protected specimen brush and quantitative culture techniques). Am Rev Respir Dis. 1989;139:877–884
  6. Torres A, Aznar R, Gatell JM, et al. Incidence, risk, and prognosis factors of nosocomial pneumonia in mechanically ventilated patients. Am Rev Respir Dis. 1990;142:523–528
  7. Duke GJ, Bersten AD. Non-invasive ventilation for adult acute respiratory failure (Part I). Crit Care Resusc. 1999;1:198
  8. Duke GJ, Bersten AD. Non-invasive ventilation for adult acute respiratory failure (Part II). Crit Care Resusc. 1999;1:210
  9. de Lucas P, Tarancon C, Puente L, et al. Nasal continuous positive airway pressure in patients with COPD in acute respiratory failure (A study of the immediate effects). Chest. 1993;104:1694–1697
  10. Ho Kwok M, Wong K. A comparison of continuous and bi-level positive airway pressure non-invasive ventilation in patients with acute cardiogenic pulmonary oedema: a meta-analysis. Crit Care. 2006;10:R49
  11. Kaye DM, Mansfield D, Naughton MT. Continuous positive airway pressure decreases myocardial oxygen consumption in heart failure. Clin Sci (Lond). 2004;106:599–603
  12. Kindgen-Milles D, Muller E, Buhl R, et al. Nasal-continuous positive airway pressure reduces pulmonary morbidity and length of hospital stay following thoracoabdominal aortic surgery. Chest. 2005;128:821–828
  13. L'Her E, Moriconi M, Texier F, et al. Non-invasive continuous positive airway pressure in acute hypoxaemic respiratory failure—experience of an emergency department. Eur J Emerg Med. 1998;5:313–318
  14. Lightowler JV, Wedzicha JA, Elliott MW, et al. Non-invasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: Cochrane systematic review and meta-analysis. BMJ. 2003;326:185
  15. Majid A, Hill NS. Noninvasive ventilation for acute respiratory failure. Curr Opin Crit Care. 2005;11:77–81
  16. Masip J, Roque M, Sanchez B, et al. Noninvasive ventilation in acute cardiogenic pulmonary edema: systematic review and meta-analysis. JAMA. 2005;294:3124–3130
  17. Naughton MT, Rahman MA, Hara K, et al. Effect of continuous positive airway pressure on intrathoracic and left ventricular transmural pressures in patients with congestive heart failure. Circulation. 1995;91:1725–1731
  18. Pang D, Keenan SP, Cook DJ, et al. The effect of positive pressure airway support on mortality and the need for intubation in cardiogenic pulmonary edema: a systematic review. Chest. 1998;114:1185–1192
  19. Peter JV, Moran JL, Phillips-Hughes J, et al. Effect of non-invasive positive pressure ventilation (NIPPV) on mortality in patients with acute cardiogenic pulmonary oedema: a meta-analysis. Lancet. 2006;367:1155–1163
  20. Rasanen J, Heikkila J, Downs J, et al. Continuous positive airway pressure by face mask in acute cardiogenic pulmonary edema. Am J Cardiol. 1985;55:296–300
  21. Rasanen J, Vaisanen IT, Heikkila J, et al. Acute myocardial infarction complicated by left ventricular dysfunction and respiratory failure (The effects of continuous positive airway pressure). Chest. 1985;87:158–162
  22. Squadrone V, Coha M, Cerutti E, et al. Continuous positive airway pressure for treatment of postoperative hypoxemia: a randomized controlled trial. JAMA. 2005;293:589–595
  23. Winck JC, Azevedo LF, Costa-Pereira A, et al. Efficacy and safety of non-invasive ventilation in the treatment of acute cardiogenic pulmonary edema—a systematic review and meta-analysis. Crit Care. 2006;10:R49
  24. Hess DR. Noninvasive positive-pressure ventilation and ventilator-associated pneumonia. Respir Care. 2005;50:924–929
  25. Alexander JL. Use of continuous positive airway pressure in rural emergency medical services systems for acute pulmonary edema. Acad Emerg Med. 2006;13(5 suppl 1):S66
  26. Hastings D, Monahan J, Gray C, et al. CPAP (A supportive adjunct for congestive heart failure in the prehospital setting). JEMS. 1998;23:58–65
  27. Hubble MW, Richards ME, Jarvis R, et al. Effectiveness of prehospital continuous positive airway pressure in the management of acute pulmonary edema. Prehosp Emerg Care. 2006;10:430–439
  28. Kallio T, Kuisma M, Alaspaa A, et al. The use of prehospital continuous positive airway pressure treatment in presumed acute severe pulmonary edema. Prehosp Emerg Care. 2003;7:209–213
  29. Kosowsky JM, Gasaway MD, Stephanides SL, et al. EMS transports for difficulty breathing: is there a potential role for CPAP in the prehospital setting?. Acad Emerg Med. 2000;7:1165
  30. Kosowsky JM, Stephanides SL, Branson RD, et al. Prehospital use of continuous positive airway pressure (CPAP) for presumed pulmonary edema: a preliminary case series. Prehosp Emerg Care. 2001;5:190–196
  31. Sullivan MP, Kiskaddon RT, Mossesso VN, et al. Continuous positive airway pressure in the prehospital treatment of acute pulmonary edema. Ann Emerg Med. 1995;25:129
  32. Pepe PE. Out-of-hospital resuscitation research: rationale and strategies for controlled clinical trials. Ann Emerg Med. 1993;22:17–23
  33. Sayre MR, White LJ, Brown LH, et al. National EMS research agenda: proceedings of the implementation symposium. Acad Emerg Med. 2003;10:1100–1108
  34. Thompson J. Ethical challenges of informed consent in prehospital research. CJEM. 2003;5:108–114
  35. Canadian Institutes of Health ResearchNatural Sciences and Engineering Council of CanadaSocial Sciences and Humanities Research Council of Canada. Tri Council policy statement: Ethical conduct for research involving humans. http://www.pre.ethics.gc.ca/english/pdf/TCPS October 2005_E.pdf1995;
  36. Petrie DA, Cain E, Tallon JM, et al. Evidence based protocols (Emergency Health Services Nova Scotia). http://emergency.medicine.dal.ca/ehsprotocols/protocols/toc.cfmAccessed November 9, 2006.
  37. Kovacs G, Law JA. Airway Management in Emergencies. New York, NY: McGraw-Hill; 2007;
  38. Alzola CF, Harrell FE. An introduction to S and the Hmisc and Design Libraries. http://lib.stat.cmu.edu/S/Harrell/doc/splus.pdf2003;Accessed October 15, 2007.
  39. Delclaux C, L'Her E, Alberti C, et al. Treatment of acute hypoxemic nonhypercapnic respiratory insufficiency with continuous positive airway pressure delivered by a face mask: A randomized controlled trial. JAMA. 2000;284:2352–2360
  40. Keim SM, Spaite DW, Maio RF, et al. Risk adjustment and outcome measures for out-of-hospital respiratory distress. Acad Emerg Med. 2004;11:1074–1081
  41. Welsford M, Morrison LJ. Defining the outcome measures for out-of-hospital trials in acute pulmonary edema. Acad Emerg Med. 2002;9:983–988
  42. Bullock G, Campbell S, Coonan TJ, et al. Prehospital airway management considerations. In:  Kovacs G,  Law JA editor. Airway Management in Emergencies. New York, NY: McGraw-Hill; 2007;
  43. Murphy MF, Petrie DA, Tallon JM. Pre-hospital airway management recommendations and controversies. In:  Hung OR,  Murphy MF,  Law JA, et al. editor. Case Studies in Difficult and Failed Airway Management. New York, NY: McGraw Hill; 2007;In press

 Supervising editor: Theodore R. Delbridge, MD, MPH

 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that might create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. This study protocol was approved by Capital District Health Authority Research Ethics Board. Their file number is CDHA 2000-305, Clinical Trials.gov Identifier NCT00405314.

 Author contributions: JT, DAP, SA-S, and DJB conceived and designed the trial. JT, DAP, SA-S, and DJB obtained the funding. JT, DAP, SA-S, and DJB supervised the conduct of the trial and data collection. SA-S supervised management of the data, including quality control. JT, DAP, and DJB supervised the recruitment by paramedics. SA-S provided statistical advice on study design and statistical methodology and conducted descriptive data analyses. JT drafted the first copy of the article, and all authors contributed substantially to its revisions. JT and DAP take responsibility for the paper as a whole.

 Publication date: Available online April 3, 2008.

PII: S0196-0644(08)00032-2

doi: 10.1016/j.annemergmed.2008.01.006

Annals of Emergency Medicine
Volume 52, Issue 3 , Pages 232-241.e1 , September 2008