Patients were eligible for enrolment if they were aged >40 years, with acute severe respiratory distress (as defined by the St John WA Clinical Practice Guideline (CPG) for Dyspnoea & Respiratory Distress) 9 of non-traumatic origin, had a RR of >22 breaths/min and were unresponsive to at least 5 min of initial treatment. Patients were screened for eligibility by the attending study paramedic.
6 The objective of this study was to assess whether the prehospital use of CPAP by paramedics reduces breathlessness (dyspnoea score and RR) and reduces hospital length of stay in patients with severe respiratory distress attended by EMS.Įnrolment commenced on 5 March 2016 and concluded 31 December 2018. However, the evidence of efficacy is limited by mostly observational studies and small clinical trials, and remains inconclusive, particularly in EMS without direct physician support, or across the spectrum of underlying pathology. 5 Some EMS (eg, Ambulance Victoria, Australia) have introduced the use of CPAP by paramedics in the prehospital setting. Non-invasive positive pressure ventilation (NIPPV) techniques such as continuous positive airway pressure (CPAP) provide ventilatory support without the need for an (invasive) endotracheal tube and have been increasingly used in the hospital setting as a treatment for ARF and alleviating respiratory distress. Current EMS guidelines in our jurisdiction (Western Australia) recommend optimising patient positioning, titrated oxygen therapy and specific management options directed at the underlying disease, 3 such as bronchodilators for COPD and glyceryl trinitrate for APO. 1 It may arise from a variety of cardiorespiratory conditions, 2 such as acute pulmonary oedema (APO), asthma and chronic obstructive pulmonary disease (COPD). Professor Judith C Finn, Prehospital, Resuscitation, and Emergency Care Research Unit (PRECRU), Curtin University, Perth, WA 6102, Australia Īcute respiratory failure (ARF), presenting as dyspnoea, is a common reason for patients to contact emergency medical (ambulance) services (EMS). 13 Emergency Department, Rockingham General Hospital, Cooloongup, Western Australia, Australia.12 Emergency Department, Armadale Kelmscott District Memorial Hospital, Armadale, Western Australia, Australia.
8 School of Public Health, Curtin University, Perth, Western Australia, Australia.7 Centre for Clinical Research in Emergency Medicine, Royal Perth Hospital, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia.6 Emergency Department, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.5 Warwick Medical School, University of Warwick, Coventry, West Midlands, UK.4 School of Medicine, The University of Western Australia, Perth, Western Australia, Australia.3 Critical Care Division, Royal Perth Hospital, Perth, Western Australia, Australia.2 St John Western Australia, Perth, Western Australia, Australia.1 Prehospital, Resuscitation, and Emergency Care Research Unit (PRECRU), Curtin University, Perth, Western Australia, Australia.
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