Factors Associated with Failure of Non-invasive Positive Pressure Ventilation in a Critical Care Helicopter Emergency Medical Service.
BACKGROUND
Non-invasive positive pressure ventilation (NIPPV) is used to treat severe acute respiratory distress. Prehospital NIPPV has been associated with a reduction in both in-hospital mortality and the need for invasive ventilation.


OBJECTIVE
The authors of this study examined factors associated with NIPPV failure and evaluated the impact of NIPPV on scene times in a critical care helicopter Emergency Medical Service (HEMS). Non-invasive positive pressure ventilation failure was defined as the need for airway intervention or alternative means of ventilatory support.


METHODS
A retrospective chart review of consecutive patients where NIPPV was completed in a critical care HEMS was conducted. Factors associated with NIPPV failure in univariate analyses and from published literature were included in a multivariable, logistic regression model.


RESULTS
From a total of 44 patients, NIPPV failed in 14 (32%); a Glasgow Coma Scale (GCS)<15 at HEMS arrival was associated independently with NIPPV failure (adjusted odds ratio 13.9; 95% CI, 2.4-80.3; P=.003). Mean scene times were significantly longer in patients who failed NIPPV when compared with patients in whom NIPPV was successful (95 minutes vs 51 minutes; 39.4 minutes longer; 95% CI, 16.2-62.5; P=.001).


CONCLUSIONS
Patients with a decreased level of consciousness were more likely to fail NIPPV. Furthermore, patients who failed NIPPV had significantly longer scene times. The benefits of NIPPV should be balanced against risks of long scene times by HEMS providers. Knowing risk factors of NIPPV failure could assist HEMS providers to make the safest decision for patients on whether to initiate NIPPV or proceed directly to endotracheal intubation prior to transport.
1Department of Emergency Medicine,University of Alberta,Edmonton,Alberta,Canada.
James S
JS
Lee
2Shock Trauma Air Rescue Society,Edmonton,Alberta,Canada.
Domhnall
D
O'Dochartaigh
1Department of Emergency Medicine,University of Alberta,Edmonton,Alberta,Canada.
Mark
M
MacKenzie
2Shock Trauma Air Rescue Society,Edmonton,Alberta,Canada.
Darren
D
Hudson
1Department of Emergency Medicine,University of Alberta,Edmonton,Alberta,Canada.
Stephanie
S
Couperthwaite
1Department of Emergency Medicine,University of Alberta,Edmonton,Alberta,Canada.
Cristina
C
Villa-Roel
1Department of Emergency Medicine,University of Alberta,Edmonton,Alberta,Canada.
Brian H
BH
Rowe
D000368:Aged; D017732:Air Ambulances; D000401:Aircraft; D000416:Alberta; D003422:Critical Care / Q000379:methods*; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000379:methods*; D011175:Positive-Pressure Respiration / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure
AECOPD acute exacerbations of chronic obstructive pulmonary disease; AMC Air Medical Crew; ED emergency department; EMS Emergency Medical Services; GCS Glasgow Coma Scale; HEMS; HEMS helicopter Emergency Medical Service; ICU intensive care unit; LOS length-of-stay; NIPPV; NIPPV non-invasive positive pressure ventilation; NNT number needed to treat; RR respiratory rate; STARS Shock Trauma Air Rescue Society; ePCR electronic Patient Care Record; non-invasive ventilation; respiratory failure