Prehospital continuous positive airway pressure (CPAP) for acute respiratory distress: a randomised controlled trial

Judith C Finn ,1,2 Deon Brink,1,2 Nicole Mckenzie,1,3 Antony Garcia,2 Hideo Tohira,1,4 Gavin D Perkins,5 Glenn Arendts,4,6 Daniel M Fatovich ,4,7 Delia Hendrie,8 Brendan McQuillan,4,9 Quentin Summers,10 Antonio Celenza ,4,11 Ashes Mukherjee ,12 Ben Smedley,13 Gavin Pereira,8 Stephen Ball,1,2 Teresa Williams,3 Paul Bailey1,2

ABSTRACT Objective To compare the efficacy of continuous positive airway pressure (CPAP) versus usual care for prehospital patients with severe respiratory distress. Methods 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. Results 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 min1 vs CPAP −8.0, IQR −14.0 to −4.0 min-1), median difference −4.0 (95% CI −5.0 to −4.0) min-1. 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). Conclusions 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.

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