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• W2141036592 abstract "Although it has been documented that the use of non-invasive positive pressure ventilation (NIPPV) in the hospital environment decreases the incidence of intubation and reduces mortality, there is very little research on whether out-of-hospital initiation of NIPPV in an urban system with short transport times achieves further improvement in outcomes. The goal of this study was to compare mortality, intubation rates, and length of hospital stay in patients who were brought in by Emergency Medical Services (EMS) before and after implementation of EMS-initiated NIPPV. The Kansas City, Kansas Fire Department (KCKFD) started using continuous positive airway pressure (CPAP), a form of NIPPV, on January 1, 2006. This service has traditionally had short transport times to the University of Kansas Hospital, which instituted NIPPV in the emergency department (ED) in 2000 in the form of bi-level positive airway pressure (BiPAP). We performed a retrospective review of hospital and EMS charts of patients from July 1, 2004 through June 30, 2008. Eligible patients were identified as those with an ED diagnosis of congestive heart failure (CHF) that were brought to University of Kansas Hospital (UKH) ED during the allotted time period. Values for the date of ED visit, patient names, and initial triage vital signs were found in the UKH database, and the patients’ vital signs and treatment provided by EMS were extracted from the KCKFD charts. The Rapid Emergency Medicine Score (REMS), which is an attenuated version of the APACHE II system, was then calculated for both EMS and ED, and then compared between the two groups, along with mortality, intubation, and length of stay. The mortality rate was decreased by more than half, with 5.4% mortality before December 31, 2005 to 2.6% after January 1, 2006 (P<.05). There was a greater general improvement in REMS scores after CPAP implementation (P<.05), with changes of initial EMS REMS to initial ED REMS decreasing by 0.42 and 0.26, respectively (P<.01). These two parameters were achieved without affecting out-of-hospital patient transport time, which was decreased by 0.4 minutes. Analysis of intubation rate revealed no significant improvement (P=.167). The data reveal that delivering NIPPV in the out-of-hospital environment achieved statistically significant decreases in mortality and mean REMS without increasing the duration between when the patient called for an ambulance and the time when they were delivered to the ED. The results did not, however, show any statistically significant difference in intubation rates, length of hospital stay, or level of care for hospital admission as a result of delivering NIPPV." @default.
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• W2141036592 date "2014-10-01" @default.
• W2141036592 modified "2023-09-25" @default.
• W2141036592 title "143 Emergency Medical Services Initiation of Non-Invasive Positive Pressure Ventilation in Urban Acute Congestive Heart Failure Patients" @default.
• W2141036592 doi "https://doi.org/10.1016/j.annemergmed.2014.07.169" @default.
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