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Utilization of Continuous Positive Airway Pressure (CPAP) by Emergency Medical Services: Updated Systematic Review
Roshan Dhakal1, Deeven Karki2, Sujha Ghimire1
1Department of Medicine, Nepal Medical College, Kathmandu, Nepal.
Galen Medical Journal
|July 11, 2024
Summary
Prehospital continuous positive airway pressure (CPAP) did not show a statistically significant difference in reducing in-hospital mortality compared to standard oxygen therapy. Further large-scale randomized trials are needed to confirm its lifesaving efficacy in respiratory failure patients.
Area of Science:
- Emergency Medicine
- Respiratory Medicine
- Critical Care
Background:
- Conflicting results exist regarding prehospital continuous positive airway pressure (CPAP) for respiratory failure.
- Previous meta-analyses suggest CPAP benefits prehospital respiratory distress patients.
- Updated pooled estimates are necessary due to growing literature.
Purpose of the Study:
- To compare prehospital CPAP with standard oxygen therapy in respiratory failure patients.
- To assess the impact of prehospital CPAP on in-hospital mortality.
- To provide updated pooled estimates on CPAP efficacy in prehospital settings.
Main Methods:
- Systematic review and meta-analysis following PRISMA guidelines.
- Searches conducted across PubMed, Web of Science, Embase, and Scopus.
- Included randomized trials comparing prehospital CPAP with standard care; analyzed in-hospital mortality using random effect models.
Main Results:
- Four articles (747 patients on CPAP, 713 on standard care) were analyzed.
- No statistically significant difference in in-hospital mortality between prehospital CPAP and standard care (P=0.16).
- A trend towards increased risk ratio in newer studies was observed (P=0.017).
Conclusions:
- Current evidence does not confirm the lifesaving efficacy of out-of-hospital CPAP.
- More randomized trials with larger sample sizes are required.
- Further research is needed to establish definitive conclusions on prehospital CPAP effectiveness.
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