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

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, 17 2: 261-273. doi:10.3109/10903127.2012.749967

Author Williams, Teresa A.
Finn, Judith
Perkins, Gavin D.
Jacobs, Ian G.
Title Prehospital continuous positive airway pressure for acute respiratory failure: a systematic review and meta-analysis
Journal name Prehospital Emergency Care   Check publisher's open access policy
ISSN 1090-3127
Publication date 2013-04
Sub-type Article (original research)
DOI 10.3109/10903127.2012.749967
Open Access Status
Volume 17
Issue 2
Start page 261
End page 273
Total pages 13
Place of publication London, United Kingdom
Publisher Informa Healthcare
Language eng
Formatted 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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Keyword Eemergency medical services
Systematic review
Acute respiratory failure
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ
Additional Notes Published April-June 2013.

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Nursing, Midwifery and Social Work Publications
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Citation counts: TR Web of Science Citation Count  Cited 8 times in Thomson Reuters Web of Science Article | Citations
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Created: Tue, 15 Jul 2014, 10:57:39 EST by Vicki Percival on behalf of School of Nursing, Midwifery and Social Work