The Impact of Prehospital Continuous Positive Airway Pressure on the Rate of Intubation and Mortality from Acute Out-of-hospital Respiratory Emergencies
Bibliographic record
Abstract
BACKGROUND: Previous studies have demonstrated decreased rates of intubation and mortality with prehospital use of continuous positive airway pressure (CPAP). We sought to validate these findings in a larger observational study. METHODS: We conducted a before and after observational study of consecutive patients transported by emergency medical services (EMS) during the 12 months before and the 12 months following implementation of a prehospital CPAP protocol for acute respiratory distress. Included were all patients transported by EMS meeting preestablished criteria indicative of acute respiratory distress and CPAP use (patient's problem specified as cardiac, respiratory distress, respiratory disease, or congestive heart failure [CHF]; age ≥ 12 years; chest sounds documented as wheezes or rales; Glascow Coma Scale [GCS] ≥ 11; respiratory rate ≥ 24 breaths per minute; systolic blood pressure ≥ 90 mmHg; and oxygen saturation < 90%). Data were abstracted from ambulance call reports (ACRs) and hospital records. All cases in which "do not resuscitate" (DNR) was documented on the patient chart or ACR or whose in-hospital outcome (death or discharge) was unknown were excluded. RESULTS: In all, 442 patients met the above criteria. The mean (SD) age was 73.0 (13.9) years, and 51.5% were women. In-hospital mortality rates did not differ for these patients: 17/228 (7.5%) in the before group and 17/214 (7.9%) in the after group (p = 0.85). In-hospital intubation rates were similar for both groups (12.7 vs. 14.5%, p = 0.59). An analysis of the subgroup that had a hospital diagnosis of chronic obstructive pulmonary disease (COPD), CHF, or pulmonary edema (n = 273) showed mortality was somewhat lower in the before group (3/138, 2.2%) than in the after group (8/135, 5.9%) (p = 0.13). In-hospital intubation rates were also similar for both groups in this subgroup analysis (11.6 vs. 9.6%, p = 0.61). CONCLUSION: In contrast to previous studies, we were unable to demonstrate a decrease in intubation or mortality related to the use of prehospital CPAP. Our findings may be specific to our EMS system but suggest that further large-scale, randomized, controlled trials may be warranted to firmly establish the benefit of prehospital CPAP.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".