Abstract. Objective: To evaluate the utility of bilevel positive airway pressure (BiPAP) in the out-of-hospital treatment of patients with presumed congestive heart failure (CHF). Methods: This was a prospective, sequential, parallel trial in an urban setting served by a single emergency medical services (EMS) system between January 4 and April 15, 1999. A convenience sampling of adults who were transported by rescue units judged to be in CHF by treating emergency medical technicians trained in advanced life support (ALS EMTs) was included. Rescue squads were divided into demographically matched pairs, and one of each was equipped with a BiPAP ventilatory support unit. Bilevel positive airway pressure therapy was added to the existing treatment protocols for eligible study patients. Main outcome measures were out-of-hospital treatment time, oxygen saturation changes, hospitalization length, need for endotracheal intubation, mortality rate, and ease of use of the device by EMS personnel. Results: Sixtytwo of 71 enrolled patients completed the study. Out-of-hospital treatment times did not differ between groups (31.2 minutes vs 31.4 minutes; p = 0.931). The difference between pre-and post-treatment oxygen saturation levels was greater for the BiPAP group (13.71%) than the control group (6.69%) (p < 0.05). There was no statistical difference between groups in the length of hospital stay [control: 7.63 days, vs BiPAP: 6.33 days, p = 0.48], the intubation rate [control: 7 of 25 (28%) vs BiPAP: 4 of 37 (11%), p = 0.10], or death rate [control: 2 of 24, vs BiPAP: 6 of 37, p = 0.46]. All of the ALS EMTs who used BiPAP thought that it was safe to use, and 97% thought it was easy and appeared to improve patients' dyspnea and respiratory distress. Conclusions: ALS EMTs can be trained to deliver noninvasive ventilation with BiPAP, find it easy to apply, and believe that it helps relieve dyspnea in patients with suspected CHF.
Background: The Public Access Defibrillation (PAD) Trial was a randomized, controlled trial designed to measure survival to hospital discharge following out-of-hospital cardiac arrest (OOH-CA) in community facilities trained and equipped to provide PAD, compared with community facilities trained to provide cardiopulmonary resuscitation (CPR) without any capacity for defibrillation. Objectives: To report the implementation of community-based lay responder emergency response programs in 1,260 participating facilities recruited for the PAD Trial in the United States and Canada. Methods: This was a descriptive study of the characteristics of participating facilities, volunteers, and automated external defibrillator (AED) placements compiled by the PAD Trial, and a qualitative study of factors that facilitated or impeded implementation of emergency lay responder programs using focus groups of PAD Trial site coordinators. Results: The PAD Trial enrolled 1,260 community facilities (14.8% residential), with 20,400 lay volunteers (mean 6 standard deviation = 13.4 6 10.7 per facility)
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.