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Background: In 2015, continuous positive airway pressure (CPAP) was incorporated in the treatment protocol of emergency medical services (EMS) in the Netherlands for acute respiratory failure. Potentially, CPAP has a positive effect on intubation rates, intensive care unit (ICU) admissions and mortality. Our aim was to study these effects. Secondary, we investigated the extent of CPAP use. Materials and Methods: This observational study compared two 6-month periods, before and after the introduction of prehospital CPAP (PCPAP). Patients were included if they were brought in by ambulance with a pulmonary cause of respiratory failure. Data were collected on blood gas results, Emergency Department length of stay, intubation, ICU admission, and mortality. In addition, a survey was held among EMS workers. Results: The before group contained 54 and the after group 46 patients. Only three patients (7%) in the after group were treated with PCPAP, while all 46 patients fulfilled the inclusion criteria. According to the survey, reasons for not applying CPAP were: short distance to the hospital, too little knowledge about CPAP for respiratory failure with a suspected pulmonary cause, mask discomfort, and satisfying results on standard therapy alone. Conclusion: In this cohort, the use of PCPAP treatment was very low, although most patients (70%) that fulfilled the inclusion criteria were admitted to the ICU. EMS workers did not feel familiar with the application of CPAP for patients with pulmonary dyspnea, despite training. Furthermore, mask discomfort showed to be an important factor, as well as the relatively short prehospital distances in the Netherlands. These results endorse the need for feasible prehospital protocols and the importance of patient comfort in the decision to provide PCPAP. More research is needed to evaluate if PCPAP in densely populated areas is beneficial.

Low adherence to a prehospital continuous positive airway pressure treatment protocol following implementation in The Netherlands