Prehospital CPAP Reduces Need For Intubation In Respiratory Emergencies

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Prehospital CPAP Reduces Need For Intubation In
Respiratory Emergencies

• Mark Marchetta, RN, BS, NREMT-P
• Mark Resanovich, EMT-P
• Aultman Health Foundation
• Canton, Ohio

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Objective

• Determine if CPAP decreased intubation rates for
  
• CHF
• Asthma
• COPD
• Pneumonia
• Pulmonary Edema

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Hypothesis

• There is a significant decrease in intubation
  rates of patients who receive CPAP versus
  conventional oxygen therapy

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Methods

• Expedited IRB Approval
• Data collection
• May 9, 2005 to May 9, 2006

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Methods - Inclusion Criteria

• Awake and able to follow commands
• Over 17 years old
• Maintain and protect own airway
• Two of the following
• Resp rate greater than 24
• Pulse Ox less than 94 at any time
• Use of accessory muscles

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Methods

• Study Group (CPAP)
• Formed by patients transported by 22 paramedic
  ambulances equipped with CPAP
• Control Group (Conventional O2 Therapy)
• Formed by patients transported by 31 paramedic
  ambulances not equipped with CPAP

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Methods

• All Patients
• Intubation rates up to 12 hours post
  hospitalization were recorded
• The time began when the patient arrived at the
  emergency department

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CHF Largest Study Group (133)

• 51 patients in CPAP Group
• 1 Intubation
• 82 patients in Control Group
• 22 Intubations
• 25 Reduction

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COPD 2nd Largest Group (98)

• 55 patients in CPAP Group
• 3 Intubations
• 43 patients in Control Group
• 15 Intubations
• 30 Reduction

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Asthma 3rd Largest Group (26)

• 19 patients in CPAP Group
• 3 Intubations
• 7 patients in Control Group
• 2 Intubations
• 12 Reduction

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Pul Edema 4th Largest Group (22)

• 15 patients in CPAP Group
• 4 Intubations
• 7 patients in Control Group
• 6 Intubations
• 60 Reduction

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Other 5th Largest Group (19)

• Had Dx Hypoxemia, Resp Acidosis, or Resp
  Failure,
• 5 patients in CPAP Group
• 2 Intubations
• 14 patients in Control Group
• 9 Intubations
• 24 Reduction

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Pneumonia (11)

• 3 patients in CPAP Group
• 0 Intubated
• 8 patients in Control Group
• 2 Intubated
• 25 Reduction

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Results

• Intubation reduction 26 with 95 CI (16.7,
  35.3)
• Chi-square 31.968 p
• Patients who did not receive CPAP were six times
  more likely to be intubated (ODDS Ratio6.061)

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Conclusion

• As a group, patients who received prehospital
  CPAP had a significantly lower incidence of
  intubation when compared to the group of patients
  who received conventional oxygen therapy.

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Excluded

• 70 Patient received CPAP and Excluded
• 52 with DNR or made DNR with in 12 hours of
  hospitalization
• 15 with decreased LOC / unable to follow commands
• 3 under age 17

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Strength Largest Study
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Strength - No Complications

• CPAP was not discontinued due to any
  complications
• Pneumothorax
• Vomiting / Aspiration
• Hypotension

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Strength - Length of Stay

• CPAP group 355 days less LOS
• 8000 per day ICUIntubation
• 56,000 increased cost for VAP
• CPAP Intubation
• 5.4 days less LOS
• ICU Admission reduced 62

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Recognition

• Published
• Presented
• Best Research
• National / International

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EMT-Basic Skill

• With the exception of IV and ECG, CPAP group did
  not receive ALS care
• Occasional proventil
• Rare Lasix administration
• No Morphine

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EMT-B Skill in Other States

• Minnesota and Wisconsin
• Over 600 EMT-B applications without complications
• Oklahoma
• New Mexico
• Florida
• Even FD Engines carry it