European Heart Journal Advance Access originally published online on October 29, 2007
European Heart Journal 2007 28(23):2895-2901; doi:10.1093/eurheartj/ehm502
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A randomized study of out-of-hospital continuous positive airway pressure for acute cardiogenic pulmonary oedema: physiological and clinical effects
1 Department of Anaesthesiology and Critical Care, Lariboisière University Hospital AP-HP, 2 Rue Ambroise Paré, Paris 75010, France
2 Department of Biostatistics, Fernand Widal Hospital, Paris 7 Denis Diderot University, Paris, France
Received 26 February 2007; revised 2 October 2007; accepted 4 October 2007; online publish-ahead-of-print 29 October 2007.
* Corresponding author. Tel: +33 1 49 95 80 85; fax: +33 1 49 95 80 73. E-mail address: didier.payen{at}lrb.aphp.fr; dpayen1234{at}aol.com
See page 2823 for the editorial comment on this article (doi:10.1093/eurheartj/ehm490)
Aims: In acute cardiogenic pulmonary oedema (ACPE), continuous positive airway pressure (CPAP) added to medical treatment improves outcome. The present study was designed to assess the benefit of CPAP as a first line treatment of ACPE in the out-of-hospital environment.
Methods and results: The protocol lasted 45 min, divided into three periods of 15 min. Patients with ACPE were randomly assigned in two groups: 1/Early CPAP (n = 63): CPAP alone (T0–T15); CPAP + medical treatment (T15–T30); medical treatment alone (T30–T45) and 2/Late CPAP (n = 61): medical treatment alone (T0–T15); medical treatment + CPAP (T15–T30); medical treatment alone (T30–T45). Primary endpoint: effect of early CPAP on a dyspnoea clinical score and on arterial blood gases. Secondary endpoints: incidence of tracheal intubation, inotropic support, and in-hospital mortality. T0–T15: CPAP alone had a greater effect than medical treatment on the clinical score (P = 0.0003) and on PaO2 (P = 0.0003). T15–T30: adding CPAP to medical treatment (late CPAP group) improved clinical score and blood gases and the two groups were no longer different at T30. T30–T45: in both groups, CPAP withdrawal worsened clinical score. Six patients in ‘early CPAP’ group vs. 16 in ‘late CPAP’ group were intubated [P = 0.01, odds-ratio: OR = 0.30 (0.09–0.89)]. Dobutamine was used only in the ‘late CPAP’ group (n = 5), (P = 0.02). Hospital death was higher in ‘late CPAP’ group (n = 8) than in ‘early CPAP’ group (n = 2) [P = 0.05, OR = 0.22 (0.04–1.0)].
Conclusion: When compared to usual medical care, immediate application of CPAP alone in out-of-hospital treatment of ACPO is significantly better improving physiological variables and symptoms and significantly reduces tracheal intubation incidence and in-hospital mortality.
Key Words: Pulmonary oedema • Immediate CPAP • Pre-hospital
The first two authors equally contributed to this work. They should both be considered as first authors.
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EHJ 2007 28: 2823-2824.[Extract] [Full Text]
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  J. Masip Early continuous positive airway pressure in acute cardiogenic pulmonary oedema Eur. Heart J., December 1, 2007; 28(23): 2823 - 2824. [Full Text] [PDF]
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