title: CPAP for acute cardiogenic pulmonary oedema from out-of-hospital to cardiac intensive care unit: a randomised multicentre study.
abstract: OBJECTIVE
  Continuous positive airway pressure (CPAP) is a useful treatment for patients with acute cardiogenic pulmonary oedema (CPE). However, its usefulness in the out-of-hospital setting has been poorly investigated and only by small and single-centre studies. We designed a multicentre randomised study to assess the benefit of CPAP initiated out of hospital.
  
  
  METHODS
  A total of 207 patients with CPE were randomly allocated by emergency mobile medical units to receive either standard treatment alone or standard treatment plus CPAP. CPAP was maintained after admission to the intensive care unit (ICU). Inclusion criteria were orthopnoea, respiratory rate greater than 25 breaths/min, pulse oximetry less than 90% in room air and diffuse crackles. The primary end point was assessed during the first 48 h and combined: death, presence of intubation criteria, persistence of either all inclusion criteria or circulatory failure at the second hour or their reappearance before 48 h. Absence of all criteria defined successful treatment.
  
  
  RESULTS
  CPAP was used for 60 min [40, 65] (median [Q1, Q3]) in the pre-hospital setting and 120 min [60, 242] in ICU and was well tolerated in all patients. Treatment was successful in 79% of patients in the CPAP group and 63% in the control group (p = 0.01), especially for persistence of inclusion criteria after 2 h (12 vs. 26%) and for intubation criteria (4 vs. 14%). CPAP was beneficial irrespective of the initial PaCO(2) or left ventricular ejection fraction.
  
  
  CONCLUSIONS
  Immediate use of CPAP in out-of-hospital treatment of CPE and until CPE resolves after admission significantly improves early outcome compared with medical treatment alone.
authors.affiliation: Département d'Anesthésie-Réanimation-SMUR, Hôpital Universitaire Lariboisière, AP-HP, 2, rue Ambroise Paré, 75010 Paris, France. lducros@free.fr
authors.forename: Laurent
authors.initials: L
authors.lastname: Ducros
authors.forename: Damien
authors.initials: D
authors.lastname: Logeart
authors.forename: Eric
authors.initials: E
authors.lastname: Vicaut
authors.forename: Patrick
authors.initials: P
authors.lastname: Henry
authors.forename: Patrick
authors.initials: P
authors.lastname: Plaisance
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Collet
authors.forename: Claire
authors.initials: C
authors.lastname: Broche
authors.forename: Papa
authors.initials: P
authors.lastname: Gueye
authors.forename: Muriel
authors.initials: M
authors.lastname: Vergne
authors.forename: David
authors.initials: D
authors.lastname: Goetgheber
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Pennec
authors.forename: Vanessa
authors.initials: V
authors.lastname: Belpomme
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Tartière
authors.forename: Sophie
authors.initials: S
authors.lastname: Lagarde
authors.forename: Marius
authors.initials: M
authors.lastname: Placente
authors.forename: Marie-Laurence
authors.initials: ML
authors.lastname: Fievet
authors.forename: Gilles
authors.initials: G
authors.lastname: Montalescot
authors.forename: Didier
authors.initials: D
authors.lastname: Payen
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D045422:Continuous Positive Airway Pressure; D005260:Female; D005602:France; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D058687:Out-of-Hospital Cardiac Arrest; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000503:physiopathology / Q000628:therapy*