title: Prehospital use of continuous positive airway pressure for acute severe congestive heart failure.
abstract: BACKGROUND
  The utility of continuous positive airway pressure (CPAP) in the in-hospital treatment of congestive heart failure (CHF) is well established. Its exact role is less clear in the prehospital arena.
  
  
  OBJECTIVE
  To describe the prehospital use of CPAP for patients presenting with acute severe heart failure in a large Emergency Medical Services system in New Jersey.
  
  
  METHODS
  Retrospective review of prehospital charts from January 1, 2005 to December 31, 2006 of patients treated for acute CHF. Inclusion criteria for eligibility for CPAP mask use were: respiratory rate > 25 breaths/min, labored and shallow breathing, bilateral rales, history of CHF, intact mental status, and prehospital clinical diagnosis of CHF. Data collected included demographics, vital signs, oxygen saturation (SaO(2)), need for endotracheal intubation (ETI), and complications.
  
  
  RESULTS
  There were 1306 charts reviewed; 387 patients met inclusion criteria. Of the 387, 149 patients had placement of CPAP (38.5%). The prehospital treatment times were (CPAP = 30 min; non-CPAP = 31 min; p < 0.01). The increase in SaO(2) for the CPAP group (9%) vs. the non-CPAP group (5%) was statistically significant (p < 0.01). Systolic blood pressure (BP) reduction (CPAP [27.1 mm Hg], non-CPAP [19.9 mm Hg], p < 0.01), diastolic BP reduction (CPAP [14.1 mm Hg], non-CPAP [7.4 mm Hg], p < 0.01), heart rate reduction (CPAP [17.2 beats/min], non-CPAP [9.6 beats/min], p < 0.01), respiratory rate reduction (CPAP [5.63], non-CPAP [4.09], p < 0.01), and ETI reduction (CPAP [2.6%], non-CPAP [5.46%], p < 0.01), all were statistically significant. Adjunctive CHF treatments were similar between the groups.
  
  
  CONCLUSIONS
  The use of CPAP for eligible patients with acute severe CHF seems to be feasible and beneficial. Large-scale randomized prospective prehospital studies are needed to validate these results.
authors.affiliation: Department of Emergency Medicine, and Observation Services, Clara Maass Medical Center-St. Barnabas Health Care System, Belleville, New Jersey 07109, USA.
authors.forename: Joe E
authors.initials: JE
authors.lastname: Dib
authors.forename: Scott A
authors.initials: SA
authors.lastname: Matin
authors.forename: Amy
authors.initials: A
authors.lastname: Luckert
mesh_terms: D000208:Acute Disease; D000368:Aged; D045422:Continuous Positive Airway Pressure / Q000706:statistics & numerical data*; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D009515:New Jersey; D012189:Retrospective Studies