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THE PRE-HOSPITAL EMERGENCY HEALTH SERVICES ADHERENCE FOR ACUTE CARDIOGENIC PULMONARY EDEMA TREATMENT PROTOCOLS
, 1
Affiliations- Ege University, Türkiye
open access
Abstract
INTRODUCTION: Acute Cardiogenic Pulmonary Edema (ACPE) has been the subject of Prehospital Emergency Health Services (PHEMS) for many years and is included in treatment protocols. Although these protocols were created from current literature information with proven accuracy, the rapid developments in the medical literature can sometimes take time to reflect on protocols and some differences may occur between the literature discussions and protocols. This study aimed to examine the differences between PHEMS protocols and current literature discussions in ACPE and the effects of these differences on PHEMS personnel.
MATERIAL AND METHODS: The present study, which was planned in descriptive type, consisted of two stages. In the first stage, the PHEMS protocols were examined worldwide, and seven protocols, which included the ACPE treatment protocols, were evaluated. In the second stage, questions were asked to the participants, including current information about the treatment of ACPE, and whether they followed up-to-date literature information. Participants were asked to answer the questions with their up-to-date knowledge regardless of the PHEMS protocols they were responsible for. The sample consisted of 600 participants and the data were collected between February and April 2022.
RESULTS: It was observed that Continuous Positive Airway Pressure (CPAP) application was included in all the protocols evaluated, that there were differences in nitrate usage dose and furosemide application, and that aggressive nitrate application was not included in any of the protocols. In this study, 67.2% of the participants stated that they followed up-to-date information about their profession; 32.7% would prefer the use of aggressive nitrate in SPD, 33.8% would apply furosemide if the patient did not feel relief after nitrate use, 29.7% would apply morphine sulfate, and 70.5% would apply CPAP if there were an indication.
CONCLUSIONS: The differences between the PHEMS protocols and the current literature on the treatment of ACPE may cause confusion among PHEMS personnel. Further studies are needed to clarify protocols for the aggressive use of nitrates and furosemide. In the case of morphine sulfate use, limitations and side effects should be stated more clearly.
Abstract
INTRODUCTION: Acute Cardiogenic Pulmonary Edema (ACPE) has been the subject of Prehospital Emergency Health Services (PHEMS) for many years and is included in treatment protocols. Although these protocols were created from current literature information with proven accuracy, the rapid developments in the medical literature can sometimes take time to reflect on protocols and some differences may occur between the literature discussions and protocols. This study aimed to examine the differences between PHEMS protocols and current literature discussions in ACPE and the effects of these differences on PHEMS personnel.
MATERIAL AND METHODS: The present study, which was planned in descriptive type, consisted of two stages. In the first stage, the PHEMS protocols were examined worldwide, and seven protocols, which included the ACPE treatment protocols, were evaluated. In the second stage, questions were asked to the participants, including current information about the treatment of ACPE, and whether they followed up-to-date literature information. Participants were asked to answer the questions with their up-to-date knowledge regardless of the PHEMS protocols they were responsible for. The sample consisted of 600 participants and the data were collected between February and April 2022.
RESULTS: It was observed that Continuous Positive Airway Pressure (CPAP) application was included in all the protocols evaluated, that there were differences in nitrate usage dose and furosemide application, and that aggressive nitrate application was not included in any of the protocols. In this study, 67.2% of the participants stated that they followed up-to-date information about their profession; 32.7% would prefer the use of aggressive nitrate in SPD, 33.8% would apply furosemide if the patient did not feel relief after nitrate use, 29.7% would apply morphine sulfate, and 70.5% would apply CPAP if there were an indication.
CONCLUSIONS: The differences between the PHEMS protocols and the current literature on the treatment of ACPE may cause confusion among PHEMS personnel. Further studies are needed to clarify protocols for the aggressive use of nitrates and furosemide. In the case of morphine sulfate use, limitations and side effects should be stated more clearly.
Keywords
acute cardiogenic pulmonary edema; prehospital emergency health services; paramedic; aggressive nitrate use
About this articleTitle
THE PRE-HOSPITAL EMERGENCY HEALTH SERVICES ADHERENCE FOR ACUTE CARDIOGENIC PULMONARY EDEMA TREATMENT PROTOCOLS
Journal
Disaster and Emergency Medicine Journal
Issue
Article type
Research paper
Published online
2023-10-18
Page views
228
Article views/downloads
160
DOI
10.5603/demj.96223
Keywords
acute cardiogenic pulmonary edema
prehospital emergency health services
paramedic
aggressive nitrate use
Authors
Sezgin Durmuş
Ali Ekşi
References (35)- Jaskółowska J, Gaszyński T. Prehospital management of the cardiogenic pulmonary edema. Journal of Public Health Nursing and Medical Rescue. 2019; 2: 43–48.
- Johnson JM. Management of acute cardiogenic pulmonary edema: a literature review. Adv Emerg Nurs J. 2009; 31(1): 36–43.
- Iqbal, M. A.,Gupta, M. Cardiogenic pulmonary edema. In: StatPearls. StatPearls Publishing, Treasure Island (FL). 2019. https://europepmc.org/article/nbk/nbk544260#abstract (15.12.2022).
- Sert ET, Kokulu K, Gul M, et al. Predictors of in-hospital mortality in patients admitted to the emergency department with cardiogenic pulmonary edema. .
- Sureka B, Bansal K, Arora A. Pulmonary edema — cardiogenic or noncardiogenic? J Family Med Prim Care. 2015; 4(2): 290.
- Elsaka O. Cardiogenic pulmonary edema. Asian Journal of Research in Cardiovascular Diseases. 2021; 3(4): 1–9.
- Howard I, Castle N, Shaikh LAl, et al. Safety and efficacy of a prehospital initiated protocol of nitrates plus non-invasive ventilation on prehospital and Emergency Department outcomes for acute cardiogenic pulmonary oedema. [preprint]. 2021.
- Purvey M, Allen G. Managing acute pulmonary oedema. Aust Prescr. 2017; 40(2): 59–63.
- Ekşi A. Prehospital emergency health services. EMA Medical Bookstore, Istanbul 2021.
- Hodroge SS, Glenn M, Breyre A, et al. Adult patients with respiratory distress: current evidence-based recommendations for prehospital care. West J Emerg Med. 2020; 21(4): 849–857.
- Turkey Prehospital Protocols, 2009. https://www.resmigazete.gov.tr/eskiler/2009/03/20090326-4-1.pdf (30.01.2023).
- Canada BCEHS Clinical Practice Guidelines, 2021. https://handbook.bcehs.ca/Content/cpgmedia/BCEHS_ClinicalPracticeGuidelines.pdf (30.01.2023).
- USA Connecticut Prehospital Protocols, 2022. https://portal.ct.gov/-/media/Departments-and-Agencies/DPH/dph/ems/pdf/statewide_protocols/2022/v20221_CTEMSStatewideProtocols_Apr2022-final.pdf (30.01.2023).
- USA Massachusetts Prehospital Protocols, 2022. https://www.mass.gov/doc/emergency-medical-services-statewide-treatment-protocols-version-20221-effective-june-1-2022/download (30.01.2023).
- Australian Clinical Practice Guidelines, 2019. https://www.ambulance.vic.gov.au/wp-content/uploads/2022/11/AVCPG-v6-18112022.pdf (30.01.2023).
- Irish Clinical Practice Guidelines, 2021. https://www.phecit.ie/PHECC/Clinical_Resources/Clinical_Practice_Guidelines__CPGs_/2021_edition_CPGs.aspx (30.01.2023).
- Israel Prehospital Protocols, 2016. https://www.mdais.org/media/1730/%D7%A4%D7%A8%D7%95%D7%98%D7%95%D7%A7%D7%95%D7%9C%D7%99%D7%9D-2016.pdf (30.01.2023).
- Twiner MJ, Hennessy J, Wein R, et al. Nitroglycerin use in the emergency department: current perspectives. Open Access Emerg Med. 2022; 14: 327–333.
- Ekşi A. Prehospital emergency care in cardiovascular system emergencies. EMA Medical Bookstore, Istanbul 2022.
- Ingbar DH. Cardiogenic pulmonary edema: mechanisms and treatment — an intensivist's view. Curr Opin Crit Care. 2019; 25(4): 371–378.
- Cekmen B, Bildik B, Bozan O, et al. Utility of non-invasive synchronized intermittent mandatory ventilation in acute cardiogenic pulmonary edema. Am J Emerg Med. 2022; 56: 71–76.
- Austin MA, Wills K, Kilpatrick D, et al. Continuous positive airway pressure plus low flow oxygen versus usual care of severe acute cardiogenic pulmonary edema in the pre-hospital setting: A randomised controlled trial. F1000Research. 2018; 7: 708.
- Killeen BM, Wolfson AB. Noninvasive positive pressure ventilation for cardiogenic pulmonary edema. Acad Emerg Med. 2020; 27(12): 1358–1359.
- Bello G, De Santis P, Antonelli M. Non-invasive ventilation in cardiogenic pulmonary edema. Ann Transl Med. 2018; 6(18): 355.
- Patrick C, Ward B, Anderson J, et al. Feasibility, effectiveness and safety of prehospital intravenous bolus dose nitroglycerin in patients with acute pulmonary edema. Prehosp Emerg Care. 2020; 24(6): 844–850.
- Perlmutter MC, Cohen MW, Stratton NS, et al. Prehospital treatment of acute pulmonary edema with intravenous bolus and infusion nitroglycerin. Prehosp Disaster Med. 2020; 35(6): 663–668.
- López-Rivera F, Cintrón Martínez HR, Castillo LaTorre C, et al. Treatment of hypertensive cardiogenic edema with intravenous high-dose nitroglycerin in a patient presenting with signs of respiratory failure: a case report and review of the literature. Am J Case Rep. 2019; 20: 83–90.
- McMahon BA, Chawla LS. The furosemide stress test: current use and future potential. Ren Fail. 2021; 43(1): 830–839.
- Pescatore R. What to D.O. Shift Away from Loop Diuretics for Pulmonary Edema. Emergency Medicine News. 2021; 43(7): 5–5.
- Brown H. Furosemide: properties, alternatives, and the medication approval process.student writing, 33. 2017. https://commons.vccs.edu/student_writing/33 (26.12.2022).
- Chioncel O, Metra M. Morphine in acute pulmonary oedema: a signal of harm but more questions than answers. Eur J Heart Fail. 2022; 24(10): 1963–1966.
- Al-Ani M, Ismael M, Winchester D. Morphine in acute pulmonary oedema treatment. Current Emergency and Hospital Medicine Reports. 2017; 5(2): 88–93.
- Witharana TN, Baral R, Vassiliou VS. Impact of morphine use in acute cardiogenic pulmonary oedema on mortality outcomes: a systematic review and meta-analysis. Ther Adv Cardiovasc Dis. 2022; 16: 17539447221087587.
- Gil V, Domínguez-Rodríguez A, Masip J, et al. Morphine use in the treatment of acute cardiogenic pulmonary edema and its effects on patient outcome: a systematic review. Curr Heart Fail Rep. 2019; 16(4): 81–88.
- Domínguez-Rodríguez A, Suero-Mendez C, Burillo-Putze G, et al. MIMO (MIdazolam versus MOrphine) Trial Investigators. Midazolam versus morphine in acute cardiogenic pulmonary oedema: results of a multicentre, open-label, randomized controlled trial. Eur J Heart Fail. 2022; 24(10): 1953–1962.