Anticholinergic
| Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
|
I
|
Supportive (Green)
|
Hospital admission
|
Patient
|
ED-MD
|
Nouira S., Bouida W., Grissa MH., et al. Magnesium sulfate versus ipratropium bromide in chronic obstructive pulmonary disease exacerbation: A randomized trial. Am J Ther 2014; 21(3):152-8. Medline
|
|
I
|
Neutral (Yellow)
|
FEV1
|
Patient
|
ED-MD
|
Koutsogiannis Z., Kelly AM. Does high dose ipratropium bromide added to salbutamol improve pulmonary function for patients with chronic obstructive airways disease in the emergency department? Aust N Z J Med 2000; 30(1):38-40. Medline
|
|
I
|
Neutral (Yellow)
|
Peak flow rate
|
Patient
|
ED-MD
|
O'Driscoll BR., Taylor RJ., Horsley MG., et al. Nebulized salbutamol with and without ipratropium bromide in acute airflow obstruction. Lancet 1989; 1:1418-20. Medline
|
|
I
|
Neutral (Yellow)
|
Forced expiratory volume
|
Patient
|
ED-MD
|
Rebuck AS., Chapman KR., Abboud R., et al. Nebulized anticholinergic and sympathomimetic treatment of asthma and chronic obstructive airway disease in the emergency room. AM J Med 1987; 82:59-64. Medline
|
Beta Agonist-Nebulized
| Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
|
I
|
Supportive (Green)
|
Paramedic Score, PEFR
|
Process
|
PH-Paramedic
|
Zehner WJ., Scott JM., Iannolo PM., et al. Terbutaline vs albuterol for out-of-hospital respiratory distress: Randomized double-blind trial. Acad Emerg Med 1995; 2(8):686-691. Medline
|
|
II
|
Supportive (Green)
|
PEFR, Respiratory Rate
|
Process
|
PH-Paramedic
|
Campbell IA., Colman SB., Mao JH., et al. An open, prospective comparison of B2 agonists given via nebuliser, nebuhaler, or pressurised inhaler by ambulance crew as emergency treatment. Thorax 1995; 50:79-80. Medline
|
|
II
|
Supportive (Green)
|
Improvement in pulmonary function
|
Patient
|
ED-MD
|
Kuhl DA., Agiri OA., Mauro LS. Beta-agonists in the treatment of acute exacerbation of chronic obstructive pulmonary disease. Ann Pharmacother 1994; 28(12):1379-88. Medline
|
|
II
|
Supportive (Green)
|
Mortality
|
Patient
|
PH-Paramedic
|
Stiell IG., et al. Advanced Life Support for Out-of-Hospital Respiratory Distress. NEJM 2007; 356:2156-64. Medline
|
|
II
|
Neutral (Yellow)
|
Partial carbon dioxide pressure in arterial blood, respiratory rate and the need for post-ED hospitalization.
|
Patient
|
|
Gueho F., Beaune S., Devillier P., Urien S., Faisy C. Modeling the effectiveness of nebulized terbutaline for decompensated chronic obstructive pulmonary disease patients in the emergency department. Medicine (Baltimore) 2016; 95(32):e4553. Medline
|
|
III
|
Supportive (Green)
|
Clinical improvement
|
Patient
|
PH-Paramedic
|
Markenson D., Foltin G., Tunik M., Cooper A., Treiber M., Caravaglia K. Albuterol Sulfate Administration by EMT-Basics: Results of a Demonstration Project. PEC 2004; 8(1):34-40. Medline
|
Magnesium
| Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
|
I
|
Neutral (Yellow)
|
Resolution of exacerbation
|
Patient
|
Other
|
Dobler CC, Morrow AS, Beuschel B, Farah MH, Majzoub AM, Wilson ME, Hasan B, Seisa MO, Daraz L, Prokop LJ, Murad MH, Wang Z. Pharmacologic Therapies in Patients With Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review With Meta-analysis. Ann Intern Med. 2020 Mar 17;172(6):413-422. doi: 10.7326/M19-3007. Epub 2020 Feb 25. PMID: 32092762. Medline
|
|
I
|
Neutral (Yellow)
|
FEV1
|
Patient
|
ED-MD
|
Jahanian F, Khatir IG, Ahidashti HA, Amirifard S. The Effect of Intravenous Magnesium Sulphate as an Adjuvant in the Treatment of Acute Exacerbations of COPD in the Emergency Department: A Double-Blind Randomized Clinical Trial. Ethiop J Health Sci. 2021 Mar;31(2):267-274. doi: 10.4314/ejhs.v31i2.9. PMID: 34158778; PMCID: PMC8188071. Medline
|
|
II
|
Supportive (Green)
|
Efficacy
|
Patient
|
ED-MD
|
Skorodin MS, Tenholder MF, Yetter B, Owen KA, Waller RF, Khandelwahl S, Maki K, Rohail T, D'Alfonso N. Magnesium sulfate in exacerbations of chronic obstructive pulmonary disease. Arch Intern Med. 1995 Mar 13;155(5):496-500. PMID: 7864705. Medline
|
|
II
|
Supportive (Green)
|
Change in Peak Expiratory Flow Rate
|
Patient
|
ED-MD
|
Vafadar Moradi E, Pishbin E, Habibzadeh SR, Talebi Doluee M, Soltanifar A. The Adjunctive Effect of Intravenous Magnesium Sulfate in Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Randomized Controlled Clinical Trial. Acad Emerg Med. 2021 Mar;28(3):359-362. doi: 10.1111/acem.14050. Epub 2020 Jul 7. PMID: 32542879. Medline
|
|
II
|
Opposes (Red)
|
FEV1
|
Patient
|
ED-MD
|
Edwards L, Shirtcliffe P, Wadsworth K, Healy B, Jefferies S, Weatherall M, Beasley R; Magnesium COPD Study Team. Use of nebulised magnesium sulphate as an adjuvant in the treatment of acute exacerbations of COPD in adults: a randomised double-blind placebo-controlled trial. Thorax. 2013 Apr;68(4):338-43. doi: 10.1136/thoraxjnl-2012-202225. Epub 2013 Jan 7. PMID: 23299960. Medline
|
|
II
|
Opposes (Red)
|
Improvement
|
Patient
|
Other
|
Shivanthan MC, Rajapakse S. Magnesium for acute exacerbation of chronic obstructive pulmonary disease: A systematic review of randomised trials. Ann Thorac Med. 2014 Apr;9(2):77-80. doi: 10.4103/1817-1737.128844. PMID: 24791169; PMCID: PMC4005165. Medline
|
|
III
|
Supportive (Green)
|
Percentage change in FEV1 and FVC
|
Process
|
ED-MD
|
Mukerji S, Shahpuri B, Clayton-Smith B, Smith N, Armstrong P, Hardy M, Marchant G, Marsh E. Intravenous magnesium sulphate as an adjuvant therapy in acute exacerbations of chronic obstructive pulmonary disease: a single centre, randomised, double-blinded, parallel group, placebo-controlled trial: a pilot study. N Z Med J. 2015 Nov 20;128(1425):34-42. PMID: 26905985. Medline
|
NiPPV
| Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
|
I
|
Supportive (Green)
|
Changes in dyspnea score and respiratory rate
|
Patient
|
PH-Paramedic
|
Finn JC, Brink D, Mckenzie N, Garcia A, Tohira H, Perkins GD, et al. Prehospital continuous positive airway pressure (CPAP) for acute respiratory distress: A randomised controlled trial. Emerg Med J 2021. Medline
|
|
I
|
Supportive (Green)
|
Mortality
|
Patient
|
ED-MD
|
Ram FSG., Picot J., Lightowler J., Weszicha JA. Non-invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2004; (3). Medline
|
|
I
|
Supportive (Green)
|
Need for tracheal intubation
|
Patient
|
PH-Paramedic
|
Thompson J., Petrie DA., Ackroyd-Stolarz S., Bardua DJ. Out-of-hospital continuous positive pressure ventilation vs usual care in acute respiratory failure: a RCT. Ann Emerg Med 2008; 52(3):232-41. Medline
|
|
I
|
Supportive (Green)
|
need for intubation
|
Patient
|
ED-MD
|
Thys F., Roeseler J., Reynaert M., Liistro G., Rodenstein DO. Noninvasive ventilation for acute respiratory failure: A prospective randomised placebo-controlled trial. Eur Respir J 2002; 20(3):545-555. Medline
|
|
I
|
Neutral (Yellow)
|
Mortality
|
Patient
|
PH-Paramedic
|
Scquizzato T, Imbriaco G, Moro F, Losiggio R, Cabrini L, Consolo F, et al. Non-Invasive Ventilation in the Prehospital Emergency Setting: A Systematic Review and Meta-Analysis. Prehosp Emerg Care 2022; 1–9. Medline
|
|
II
|
Supportive (Green)
|
Management, treatment indicator
|
Patient
|
PH-Paramedic & MD
|
Dunand A, Beysard N, Maudet L, Carron PN, Dami F, Piquilloud L, et al. Management of respiratory distress following prehospital implementation of noninvasive ventilation in a physician-staffed emergency medical service: a single-center retrospective study. Scand J Trauma Resusc Emerg Med 2021; 29(1):85. Medline
|
|
II
|
Supportive (Green)
|
Mortality, Time to intubation
|
Patient
|
ED-MD
|
Wood KA., Lewis L., Von Harz B., Kollef MH. The use of noninvasive positive pressure ventilation in the emergency department: results of a randomized clinical trial. Chest 1998; 113(5):1339-1346. Medline
|
|
II
|
Neutral (Yellow)
|
Intubation rate
|
Process
|
PH-Paramedic
|
Cheskes S., Turner L., Thomson S., Aljerian N. The Impact of Prehospital Continuous Positive Airway Pressure on the Rate of Intubation and Mortality from Acute Out-of-hospital Respiratory Emergencies. Prehosp Emerg Care 2013; 17(4):435-41. Medline
|
|
II
|
Neutral (Yellow)
|
Patient selection
|
Process
|
PH-MD & CCT
|
Pinczon J, Terzi N, Usseglio-Polatera P, Gheno G, Savary D, Debaty G, et al. Outcomes of Patients Treated with Prehospital Noninvasive Ventilation: Observational Retrospective Multicenter Study in the Northern French Alps. J Clin Med 2021; 10(7). Medline
|
|
III
|
Supportive (Green)
|
Respiratory Rate and SpO2
|
Patient
|
PH-Paramedic
|
Bledsoe BE., Anderson E., Hodnick R., Johnson L., Johnson S., Dievendorf E. Low-fractional oxygen concentration continuous positive airway pressure is effective in the prehospital setting. Prehosp Emerg Care 2012; 16(2):217-21. Medline
|
|
III
|
Supportive (Green)
|
Practicability and efficacy of prehospital NIV
|
Patient
|
PH-Paramedic
|
Schmidbauer W., Ahlers O., Spies C., Dreyer A., Mager G., Kerner T. Early prehospital use of non-invasive ventilation improves acute respiratory failure in acute exacerbation of chronic obstructive pulmonary disease. Emerg Med J 2011; 28(7):626-7. Medline
|
Oxygen-high flow
| Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
|
I
|
Opposes (Red)
|
Mortality
|
Patient
|
PH-Paramedic
|
Austin MA., Wills KE., Blizzard L., Walters EH., Wood-Baker R. Effect of high flow oxygen on mortality in COPD a Prehospital RCT. BMJ 2010; 341:c5462. Medline
|
|
II
|
Opposes (Red)
|
Association between PaO2 and adverse outcomes
|
Process
|
ED-MD
|
Cameron L., Pilcher J., Weatherall M., Beasley R., Perrin K. The risk of serious adverse outcomes associated with hypoxaemia and hyperoxaemia in acute exacerbations of COPD. Postgrad Med J 2012; 88(1046):684-9. Medline
|
|
II
|
Opposes (Red)
|
Targeted SpO2
|
Process
|
|
Chow JW., Khullar K., Katechia K., Klim S., Kelly AM. Controlled oxygen therapy at emergency department presentation increases the likelihood of achieving target oxygen saturations in patients with exacerbations of chronic obstructive pulmonary disease. Emerg Med Australas 2016; 28(1):44-7. Medline
|
|
III
|
Neutral (Yellow)
|
PaO2
|
Process
|
ED-MD
|
Ford DJ., Rothwell RP. Safe oxygen in acute asthma: Prospective trial using 35% ventimask prior to admission. Resp Med 1989; 83:189-94. Medline
|
|
III
|
Opposes (Red)
|
Risk of hypercapnea
|
Patient
|
PH-Paramedic
|
Durrington HJ., Flubacher M., Ramsay CF., Howard LS., Harrison BD. Initial oxygen management in patients with an exacerbation of chronic obstructive pulmonary disease. QJM 2005; 98(7):499-504. Medline
|
Oxygen-titrated
| Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
|
I
|
Supportive (Green)
|
Mortality
|
Patient
|
PH-Paramedic
|
Austin MA., Wills KE., Blizzard L., Walters EH., Wood-Baker R. Effect of high flow oxygen on mortality in COPD a Prehospital RCT. BMJ 2010; 341:c5462. Medline
|
|
II
|
Supportive (Green)
|
Association between PaO2 and adverse outcomes
|
Process
|
ED-MD
|
Cameron L., Pilcher J., Weatherall M., Beasley R., Perrin K. The risk of serious adverse outcomes associated with hypoxaemia and hyperoxaemia in acute exacerbations of COPD. Postgrad Med J 2012; 88(1046):684-9. Medline
|
|
II
|
Supportive (Green)
|
Targeted SpO2
|
Process
|
|
Chow JW., Khullar K., Katechia K., Klim S., Kelly AM. Controlled oxygen therapy at emergency department presentation increases the likelihood of achieving target oxygen saturations in patients with exacerbations of chronic obstructive pulmonary disease. Emerg Med Australas 2016; 28(1):44-7. Medline
|
|
III
|
Supportive (Green)
|
Risk of hypercapnea
|
Patient
|
PH-Paramedic
|
Durrington HJ., Flubacher M., Ramsay CF., Howard LS., Harrison BD. Initial oxygen management in patients with an exacerbation of chronic obstructive pulmonary disease. QJM 2005; 98(7):499-504. Medline
|
|
III
|
Neutral (Yellow)
|
Recovery times
|
Process
|
ED-MD
|
Ford DJ., Rothwell RP. Safe oxygen in acute asthma: Prospective trial using 35% ventimask prior to admission. Resp Med 1989; 83:189-94. Medline
|