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Prehospital continuous positive airway pressure for acute respiratory failure : a systematic review and meta-analysis
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Williams, Teresa A., Finn, Judith, Perkins, Gavin D. and Jacobs, Ian G. (2013) Prehospital continuous positive airway pressure for acute respiratory failure : a systematic review and meta-analysis. Prehospital Emergency Care, Volume 17 (Number 2). pp. 261-273. doi:10.3109/10903127.2012.749967 ISSN 1090-3127.
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Official URL: http://dx.doi.org/10.3109/10903127.2012.749967
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.
| Item Type: | Journal Article | ||||
|---|---|---|---|---|---|
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Journal or Publication Title: | Prehospital Emergency Care | ||||
| Publisher: | Informa Healthcare | ||||
| ISSN: | 1090-3127 | ||||
| Official Date: | 2013 | ||||
| Dates: |
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| Volume: | Volume 17 | ||||
| Number: | Number 2 | ||||
| Page Range: | pp. 261-273 | ||||
| DOI: | 10.3109/10903127.2012.749967 | ||||
| Status: | Peer Reviewed | ||||
| Publication Status: | Published | ||||
| Access rights to Published version: | Restricted or Subscription Access |
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