Background
Methods
Study design
Setting
Participants
Standard prehospital care and intervention
Variables and data collection
Statistical methods
Ethical approval
Results
Adherence and adverse events related to prehospital CPAP treatment
CPAP (N = 171) | |
---|---|
None | 156 |
Hypotensionab
| 4 |
Hereof discontinued CPAP: 1 | |
Nausea | 3 |
Hereof discontinued CPAP: 3 | |
Decrease in level of consciousnessc
| 2 |
Hereof discontinued CPAP: 0 | |
Worsening dyspnoea | 2 |
Hereof discontinued CPAP: 1 | |
Suspected pneumothorax | 1 |
Hereof discontinued CPAP: 1 | |
Tachycardia | 1 |
Coughing mucus | 1 |
Dry nose and/or mouth | 1 |
In-hospital outcomes in CPAP treated patients
CPAP (N = 168) | |
---|---|
Days in hospital, median (IQR) | 5.5 (3.0–9.0) |
Admitted to ICU, N (%) | 45 (27 %) |
Mortality | |
In-hospital, all patients, N (%) | 24 (14 %) |
In-hospital, ICU patients, N (%) | 11 (24 %) |
30 daysa, N (%) | 36 (24 %) |
Patient characteristics in CPAP versus non-CPAP groups in the prehospital setting
CPAP (N = 171) | Non-CPAP (N = 739) |
ρ-value | |
---|---|---|---|
Patient demographics | |||
Male, % | 60 % | 50%a
| 0.02 |
Age, years, median (IQR) | 73 (64–80) | 74 (64–81)b
| 0.99 |
Presumed cause of ARF | |||
Acute cardiopulmonary oedema | 18.1 % | 13.3 % | 0.10c
|
Asthma, acute exacerbation | 5.3 % | 7.3 % | 0.34c
|
COPD, acute exacerbation | 57.3 % | 45.5 % | 0.01c
|
Combined COPD and acute cardiopulmonary oedema | 2.3 % | 3.4 % | 0.63d
|
Combined COPD and asthma | 1.2 % | 4.2 % | 0.07d
|
Other | 12.9 % | 14.2 % | 0.65c
|
Unknown or not reported | 2.9 % | 12.2 % | <0.01d
|
CPAP | Non-CPAP |
ρ-value | |
---|---|---|---|
Status on arrival at scene | |||
SpO2, % | 87 (77–94) | 92 (85–97) | <0.01 |
(N = 159) | (N = 723) | ||
Respiratory rate, breaths/min | 32 (28–38) | 28 (24–32) | <0.01 |
(N = 163) | (N = 692) | ||
Systolic blood pressurea, mmHg | 157 (± 34) | 155 (± 33) | 0.51 |
(N = 159) | (N = 704) | ||
Diastolic blood pressurea, mmHg | 92 (± 24) | 93 (± 24) | 0.93 |
(N = 145) | (N = 704) | ||
Status on arrival at hospital | |||
SpO2, % | 96 (94–99) | 96 (91–98) | 0.02 |
(N = 168) | (N = 715) | ||
Respiratory rate, breaths/min | 25 (21–30) | 24 (21–30) | 0.67 |
(N = 163) | (N = 550) | ||
Systolic blood pressurea, mmHg | 140 (± 25) | 142 (± 30) | 0.25 |
(N = 156) | (N = 679) | ||
Diastolic blood pressurea, mmHg | 85 (± 19) | 86 (± 24) | 0.59 |
(N = 145) | (N = 676) |
Effectiveness of prehospital CPAP versus non-CPAP treatment
SpO2 on arrival at scene | ||||||
---|---|---|---|---|---|---|
71–80 % | 81–90 % | >90 % | ||||
CPAP | Non-CPAP | CPAP | Non-CPAP | CPAP | Non-CPAP | |
Unadjusted | +16.2* | +9.4* | +9.8* | +5.9* | +1.5 | 0 |
Adjusted for sex and age | +16.5* | +9.2* | +9.9* | +6.0* | +1.6 | −0.1 |
Concurrent prehospital management in CPAP versus non-CPAP groups
CPAP (N = 171) | Non-CPAP (N = 739) |
ρ-value | |
---|---|---|---|
Intravenous | |||
Furosemide, N (%) | 50 (29 %) | 152 (21 %) | 0.01 |
Fentanyl, N (%) | 29 (17 %) | 88 (12 %) | 0.08 |
Sublingual spray | |||
Nitroglycerine, N (%) | 46 (27 %) | 140 (19 %) | 0.02 |
Inhalation | |||
Salbutamol, N (%) | 108 (63 %) | 589 (80 %) | <0.01 |