Practical use, effects and complications of prehospital treatment of acute cardiogenic pulmonary edema using the Boussignac CPAP system

BACKGROUND: Early use of continuous positive airway pressure (CPAP) has been shown to be beneficial within the setting of acute cardiogenic pulmonary edema (ACPE). The Boussignac CPAP system (BCPAP) was therefore introduced into the protocols of emergency medical services (EMS) in a large urban region. This study evaluates the implementation, practical use and complications of this prehospital treatment. METHODS: This was a retrospective case series study. The study was carried out in a period shortly after the implementation of the BCPAP system on all EMS ambulances in the The Hague region. According to protocol, diagnosis of ACPE in the prehospital setting was left to the discretion of the EMS paramedics and the facial mask was applied immediately after the diagnosis had been made. Patients were selected through hospital registration and diagnostic criteria for ACPE. Only those patients showing evident clinical signs of ACPE were included. Patient characteristics, physiologic variables, clinical outcomes and complications were collected from EMS transport reports and hospital records. RESULTS: Between 1 June 2008 and 30 April 2009 a total of 180 patients were admitted for ACPE. Of these, 76 (42%) had evident clinical signs of ACPE upon presentation and were included. Three patients were transferred and in 14 cases data were missing. Out of the remaining 59 patients, 16 (27%) received BCPAP. In 43 (73%) cases the mask was not applied. For 7 out of 43 cases that were eligible for BCPAP treatment but did not receive the facial mask, an explanation was found in the EMS transport record. No complications were recorded pertaining to using the BCPAP system. CONCLUSIONS: A significant portion of patients with clinical signs of acute cardiogenic pulmonary edema in the prehospital setting is not treated according to protocol using BCPAP. Based on the small group of patients that actually received BCPAP treatment, the facial mask seems feasible and effective for the treatment of acute cardiogenic pulmonary edema in the prehospital setting.