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    Prehospital continuous positive airway pressure for acute respiratory failure: a systematic review and meta-analysis

    197130_197130.pdf (644.1Kb)
    Access Status
    Open access
    Authors
    Williams, Teresa
    Finn, Judith
    Perkins, Gavin
    Jacobs, Ian
    Date
    2013
    Type
    Journal Article
    
    Metadata
    Show full item record
    Citation
    Williams, Teresa and Finn, Judith and Perkins, Gavin and Jacobs, Ian. 2013. Prehospital continuous positive airway pressure for acute respiratory failure: a systematic review and meta-analysis. Prehospital Emergency Care. 17 (2): pp. 261-273.
    Source Title
    prehospital emergency care
    DOI
    10.3109/10903127.2012.749967
    ISSN
    1090-3127
    Remarks

    Copyright © 2013 (UK) National Association of EMS Physicians, National Association of State EMS Officials, National Association of EMS Educators, National Association of EMTs. Published by Informa UK.

    URI
    http://hdl.handle.net/20.500.11937/31688
    Collection
    • Curtin Research Publications
    Abstract

    Introduction. Acute respiratory failure (ARF) is a common problem encountered by emergency medical services and is associated with significant morbidity, mortality, and health care costs. Continuous positive airway pressure (CPAP) is an integral part of the hospital treatment of acute ARF, predominantly because of congestive heart failure. Intuitively, better patient outcomes may be achieved when CPAP is applied early in the prehospital setting, but there are few outcome studies to validate its use in this setting. Objective. This systematic review and meta-analysis aimed to examine the effectiveness of CPAP in the prehospital setting for patients with ARF. Methods. A literature review of bibliographic databases and secondary sources was conducted and potential papers were assessed by two independent reviewers. Included studies were those that compared CPAP therapy (and usual care) with no CPAP for ARF in the prehospital setting. Studies of other methods of noninvasive ventilation were not included. Methodologic quality was assessed using guidelines from the Cochrane Collaboration. Outcomes included the number of intubations, mortality, physiologic parameters, and dyspnea score. Forrest plots were constructed to estimate the pooled effect of CPAP on outcomes.Results. Five studies (1,002 patients) met the selection criteria—three randomized controlled trials (RCTs), a nonrandomized comparative study, and a retrospective comparative study using chart review. Forty-seven percent of the patients were allocated to the CPAP group. Baseline characteristics were similar between groups. The pooled estimates demonstrated significantly fewer intubations (odds ratio [OR] 0.31; 95% confidence interval [CI] 0.19–0.51) and lower mortality (OR 0.41; 95% CI 0.19–0.87) in the CPAP group. Conclusion. The studies included in this review showed a reduction in the number of intubations and mortality in patients with ARF who received CPAP in the prehospital setting. The results may not be applicable to other health care contexts because of the inherent differences in the organization and staffing of the EMS systems. Information from large RCTs on the efficacy of CPAP initiated early in the prehospital setting is critical to establishing the evidence base underpinning this therapy before ambulance services incorporate CPAP as routine clinical practice.

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