title: Assessment of the addition of prehospital continuous positive airway pressure (CPAP) to an urban emergency medical services (EMS) system in persons with severe respiratory distress.
abstract: BACKGROUND
  The use of continuous positive airway pressure (CPAP) assisted ventilation in the emergency department(ED) has been well described.
  
  
  OBJECTIVE
  The purpose of this study was to measure the efficacy of adding pre-hospital CPAP to an urban emergency medical service (EMS) respiratory distress protocol on persons with respiratory distress.
  
  
  METHODS
  A historical cohort analysis of consecutive patients between 2005 and 2010. Groups were matched for severity of respiratory distress. Physiologic variables were the primary outcome obtained from first responders and upon triage in the ED. Additional outcomes included endotracheal intubation rate, hospital mortality, overall hospital length of stay(LOS), intensive care unit (ICU) admission, and ICU length of stay (ICU LOS).
  
  
  RESULTS
  There were 410 consecutive patients with predetermined criteria for severe respiratory distress, 235 historical controls matched with 175 post-implementation patients. Average age was 67 years, 54% being male. There were significant median differences in heart and respiratory rates favoring the historical cohort (p < 0.05). There were no significant differences in intubation rate, overall hospital LOS, ICU admission rate, ICU LOS, and hospital mortality (p > 0.05).Patients that were continued on noninvasive ventilatory assistance had a significantly improved rate of intubation and ICU LOS (p < 0.05).
  
  
  CONCLUSIONS
  The addition of CPAP to our pre-hospital respiratory distress protocol did not improve physiologic variables.There were no differences in overall and ICU LOS between groups. Persons with apparent continued ventilatory assistance appeared to have improved rates of intubation and ICU LOS [corrected].
authors.affiliation: Department of Emergency Medicine, University of California San Diego Medical Center, San Diego, California 92103-8819, USA.
authors.forename: Steve A
authors.initials: SA
authors.lastname: Aguilar
authors.forename: Jonathon
authors.initials: J
authors.lastname: Lee
authors.forename: James V
authors.initials: JV
authors.lastname: Dunford
authors.forename: Edward
authors.initials: E
authors.lastname: Castillo
authors.forename: Bryan
authors.initials: B
authors.lastname: Lam
authors.forename: Jennifer
authors.initials: J
authors.lastname: Choy
authors.forename: Ekta
authors.initials: E
authors.lastname: Patel
authors.forename: John
authors.initials: J
authors.lastname: Pringle
authors.forename: John
authors.initials: J
authors.lastname: Serra
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D045422:Continuous Positive Airway Pressure; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000628:therapy*; D014481:United States
keywords: continuous positive airway pressure; emergency medical services; non-invasive positive pressure ventilation; prehospital; respiratory distress