Prehospital use of continuous positive airway pressure for acute severe congestive heart failure.

BACKGROUND: The utility of continuous positive airway pressure (CPAP) in the in-hospital treatment of congestive heart failure (CHF) is well established. Its exact role is less clear in the prehospital arena. OBJECTIVE: To describe the prehospital use of CPAP for patients presenting with acute severe heart failure in a large Emergency Medical Services system in New Jersey. METHODS: Retrospective review of prehospital charts from January 1, 2005 to December 31, 2006 of patients treated for acute CHF. Inclusion criteria for eligibility for CPAP mask use were: respiratory rate > 25 breaths/min, labored and shallow breathing, bilateral rales, history of CHF, intact mental status, and prehospital clinical diagnosis of CHF. Data collected included demographics, vital signs, oxygen saturation (SaO(2)), need for endotracheal intubation (ETI), and complications. RESULTS: There were 1306 charts reviewed; 387 patients met inclusion criteria. Of the 387, 149 patients had placement of CPAP (38.5%). The prehospital treatment times were (CPAP = 30 min; non-CPAP = 31 min; p < 0.01). The increase in SaO(2) for the CPAP group (9%) vs. the non-CPAP group (5%) was statistically significant (p < 0.01). Systolic blood pressure (BP) reduction (CPAP [27.1 mm Hg], non-CPAP [19.9 mm Hg], p < 0.01), diastolic BP reduction (CPAP [14.1 mm Hg], non-CPAP [7.4 mm Hg], p < 0.01), heart rate reduction (CPAP [17.2 beats/min], non-CPAP [9.6 beats/min], p < 0.01), respiratory rate reduction (CPAP [5.63], non-CPAP [4.09], p < 0.01), and ETI reduction (CPAP [2.6%], non-CPAP [5.46%], p < 0.01), all were statistically significant. Adjunctive CHF treatments were similar between the groups. CONCLUSION: The use of CPAP for eligible patients with acute severe CHF seems to be feasible and beneficial. Large-scale randomized prospective prehospital studies are needed to validate these results.

Analysis and applicability of the Dutch EMS system into countries developing EMS systems.

Development of an Emergency Medical Services (EMS) system is a challenging task for administrators, government agencies, and politicians. Factors such as the political climate, governmental support, and monetary resources heavily influence and shape the development of an EMS system. There are various systems in place to meet the functional needs and abilities of different regions while maintaining the basic principle of providing fast attention to those in need, and transportation to a definitive care facility. In this report, we describe the current Dutch EMS system in Amsterdam and the methods of daily pre-hospital health care delivery used, while exploring its potential applicability in developing nations. The Dutch EMS system is a nurse-driven triage system, both at the dispatch level and at the treatment level. Of the approximate yearly 165,000 calls received at the dispatch center, 40% of the requests were triaged based on national protocols such that no emergency ambulance dispatching was necessary. Furthermore, 30% of patients were treated at the scene, and did not subsequently require emergency transport to a definitive care facility.