title: Is helmet CPAP first line pre-hospital treatment of presumed severe acute pulmonary edema?
abstract: OBJECTIVE
  Non-invasive continuous positive airway pressure (CPAP) is effective in reducing intubation rate and mortality of patient with acute cardiogenic pulmonary edema (ACPE). We report our experience on pre-hospital application of CPAP by helmet as an adjunct to medical therapy or as a stand alone procedure in patient with presumed ACPE.
  
  
  METHODS
  In pre-hospital treatment of 62 patients with presumed ACPE, CPAP was added to standard medical treatment while in another 59 patients, CPAP was used as a sole therapy.
  
  
  RESULTS
  Helmet CPAP was feasible in all patients. No patient required pre-hospital intubation. In both groups, CPAP significantly improved oxygenation (SpO(2) went from 79 +/- 12 to 97 +/- 3% and from 81 +/- 13 to 98 +/- 3%), reduced respiratory rate (from 26 +/- 4 to 21 +/- 3 bpm and from 30 +/- 9 to 22 +/- 8 bpm) and improved hemodynamics, with a more pronounced decrease in blood pressure in the group with medical treatment than in the one without it. In the two cohorts, four and five patients were, respectively, intubated in Emergency Department and 11 and 9 eventually died.
  
  
  CONCLUSIONS
  Helmet CPAP is feasible, efficient and safe in pre-hospital treatment of presumed ACPE. A significant improvement of physiological variables was observed also in the group treated with CPAP in the absence of a drug therapy. We propose helmet CPAP as first line pre-hospital treatment of presumed severe ACPE.
authors.affiliation: Department of Perioperative Medicine and Intensive Care, San Gerardo Hospital, Via Pergolesi 33, 20052, Monza (MI), Italy. g.foti@hsgerardo.org
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Foti
authors.forename: Fabio
authors.initials: F
authors.lastname: Sangalli
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Berra
authors.forename: Stefano
authors.initials: S
authors.lastname: Sironi
authors.forename: Marco
authors.initials: M
authors.lastname: Cazzaniga
authors.forename: Gian Piera
authors.initials: GP
authors.lastname: Rossi
authors.forename: Giacomo
authors.initials: G
authors.lastname: Bellani
authors.forename: Antonio
authors.initials: A
authors.lastname: Pesenti
mesh_terms: D000208:Acute Disease; D000368:Aged; D000553:Ambulatory Care; D045422:Continuous Positive Airway Pressure / Q000295:instrumentation*; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006260:Head Protective Devices; D006801:Humans; D008297:Male; D010092:Oximetry; D010100:Oxygen / Q000627:therapeutic use; D011654:Pulmonary Edema / Q000628:therapy*; D012119:Respiration; D012720:Severity of Illness Index
chemical_list: D010100:Oxygen