Weekly Article: Pre-Hospital CPAP

by Seph Morrison

So as I have been working on a lecture for the upcoming EMS conference and have been doing some research on CPAP. The question is whether EMS should start initiating CPAP in the field prior to transport of children with acute respiratory distress.

Currently this is being done in the adult population, especially for pulmonary edema secondary to congestive heart failure, COPD and asthma. There is not a lot of supportive evidence, but one study does suggest pre-hospital use of CPAP may lead to an absolute reduction in tracheal intubation and mortality! (Thompson J. Ann of Emer Med 2008)

Most of the pediatric experience is with interhospital neonatal transports. One study suggests it is a safe mode of transport for our teeny tinies (Bomont, Arch Dis Child Fetal Neonatal Ed 2006) and the other indicates the frequent need for advanced pediatric airway skills. (Baird J, Prehospital Emergency Care 2009)

I believe our EMS colleagues may face significant challenges with our varied age groups but there may also be some utility in this practice. The bottom line is, as it often is in Peds: more studies are needed!!! Maybe this may be a good one for our EMS inclined folks.

Have a great week…from across the river and in your own yard…