Ambulance CPAP Saves Lives: why don't we use it?
Abstract
Continuous positive airway pressure (CPAP) is an established in-hospital therapy for the treatment of multiple aetiologies of breathlessness, primarily for acute cardiogenic pulmonary oedema (ACPE) due to acute exacerbations of congestive heart failure (CHF), but also (amongst others): exacerbations of chronic obstructive pulmonary disease (COPD), asthma and pneumonia (
The use of CPAP as an adjunctive treatment for ACPE patients in front-line ambulances has been proven to improve patient outcome, preventing them from reaching the ‘point of no return’ and a downward spiral into total respiratory failure.
This article will discuss current UK ambulance practice and examine the issues surrounding the introduction and use of CPAP as an adjunctive therapy in the treatment of ACPE, secondary to acutely exacerbated CHF, whilst also briefly discussing its use in other aetiologies of breathlessness.
One of the fundamental tenets of ambulance practice is the amelioration of patients' symptoms. Effective and timely treatment whilst in the ambulance can have a significant and positive impact on the prognosis of patients who are transported to the emergency department (ED) (Ducros et al, 2011).
Calls to patients suffering from difficulty in breathing (DIB) secondary to congestive heart failure (CHF) comprise a significant portion of emergency ambulance crews' workload. Indeed, heart failure is a worldwide major cause of mortality and morbidity, with its acute exacerbation being a leading reason for the hospitalisation and intensive therapeutic treatment of patients aged >65 years in the USA, Europe and Australasia (Fonarrow, 2008).
Continuous positive airway pressure (CPAP) is an established in-hospital therapy for the treatment of multiple aetiologies of breathlessness, primarily for acute cardiogenic pulmonary oedema (ACPE) due to acute exacerbations of CHF, but also (amongst others): exacerbations of chronic obstructive pulmonary disease (COPD), asthma and pneumonia (Gray et al, 2009; Wesley et al, 2011).
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