Prehospital, Resuscitation, and Emergency Care Research Unit (PRECRU), Curtin University, Perth, Western Australia, Australia
St John Western Australia, Perth, Western Australia, Australia.
Emerg Med J. 2022 Jan;39(1):37-44. doi: 10.1136/emermed-2020-210256. Epub 2021 Mar 26.
To compare the efficacy of continuous positive airway pressure (CPAP) versus usual care for prehospital patients with severe respiratory distress.
We conducted a parallel group, individual patient, non-blinded randomised controlled trial in Western Australia between March 2016 and December 2018. Eligible patients were aged ≥40 years with acute severe respiratory distress of non-traumatic origin and unresponsive to initial treatments by emergency medical service (EMS) paramedics. Patients were randomised (1:1) to usual care or usual care plus CPAP. The primary outcomes were change in dyspnoea score and change in RR at ED arrival, and hospital length of stay.
708 patients were randomly assigned (opaque sealed envelope) to usual care (n=346) or CPAP (n=362). Compared with usual care, patients randomised to CPAP had a greater reduction in dyspnoea scores (usual care -1.0, IQR -3.0 to 0.0 vs CPAP -3.5, IQR -5.2 to -2.0), median difference -2.0 (95% CI -2.5 to -1.6); and RR (usual care -4.0, IQR -9.0 to 0.0 min vs CPAP -8.0, IQR -14.0 to -4.0 min), median difference -4.0 (95% CI -5.0 to -4.0) min. There was no difference in hospital length of stay (usual care 4.2, IQR 2.1 to 7.8 days vs CPAP 4.8, IQR 2.5 to 7.9 days) for the n=624 cases admitted to hospital, median difference 0.36 (95% CI -0.17 to 0.90).
The use of prehospital CPAP by EMS paramedics reduced dyspnoea and tachypnoea in patients with acute respiratory distress but did not impact hospital length of stay.
ACTRN12615001180505.
比较持续气道正压通气（CPAP）与常规护理对院前严重呼吸窘迫患者的疗效。
我们在 2016 年 3 月至 2018 年 12 月期间在澳大利亚西部进行了一项平行组、个体患者、非盲随机对照试验。符合条件的患者年龄≥40 岁，有非创伤性起源的急性严重呼吸窘迫，且对急救医疗服务（EMS）护理人员的初始治疗无反应。患者被随机（1:1）分配到常规护理或常规护理加 CPAP。主要结局是 ED 到达时呼吸困难评分和 RR 的变化，以及住院时间。
708 名患者被随机分配（不透明密封信封）到常规护理（n=346）或 CPAP（n=362）。与常规护理相比，接受 CPAP 治疗的患者呼吸困难评分降低更大（常规护理-1.0，IQR-3.0 至 0.0 与 CPAP-3.5，IQR-5.2 至-2.0），中位数差异-2.0（95%CI-2.5 至-1.6）；RR（常规护理-4.0，IQR-9.0 至 0.0 min 与 CPAP-8.0，IQR-14.0 至-4.0 min），中位数差异-4.0（95%CI-5.0 至-4.0）min。因 n=624 例入院患者的住院时间无差异（常规护理 4.2，IQR 2.1 至 7.8 天与 CPAP 4.8，IQR 2.5 至 7.9 天），中位数差异 0.36（95%CI-0.17 至 0.90）。
EMS 护理人员院前使用 CPAP 可减轻急性呼吸窘迫患者的呼吸困难和呼吸急促，但对住院时间没有影响。
ACTRN12615001180505。
