Diuretic
| Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
|
I
|
Neutral (Yellow)
|
Mortality, Mechanical ventilation, Myocardial Infarction
|
Patient
|
PH-Paramedic
|
Cotter G., Metzkor E., Kaluski E., et al. Randomized trial of high-dose isosorbide dinitrate plus low-dose furosemide versus high-dose furosemide plus low-dose isosorbide dinitrate in severe pulmonary edema. The Lancet 1998; 351:389-3. Medline
|
|
II
|
Supportive (Green)
|
All cause in hospital mortality
|
Patient
|
|
Matsue Y, Damman K, Voors AA, Kagiyama N, Yamaguchi T, Kuroda S, et al. Time-to-Furosemide Treatment and Mortality in Patients Hospitalized With Acute Heart Failure. J Am Coll Cardiol 2017; 69(25):3042-51. Medline
|
|
II
|
Supportive (Green)
|
Increase in creatinine
|
Patient
|
PH-Paramedic
|
Nieves LC., Mehrtens GM., Pores N., et al. The effect of furosemide dose administered in the out-of-hospital setting on renal function among patients with suspected acute decompensated heart failure. Prehosp Disaster Med 2015; 30(1):38-45. 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)
|
Mortality
|
Patient
|
|
Gardtman M., Waagstein L., Karlsson T., Herlitz J. Has an intensified treatment in the ambulance of patients with acute severe left heart failure improved the outcomes? European Journal of Emer Med 2000; 7:15-24. Medline
|
|
II
|
Neutral (Yellow)
|
7 day mortality
|
Patient
|
ED-MD
|
Gray A., Goodacre S., Seah M., Tilley S. Diuretic, opiate and nitrate use in severe acidotic acute cardiogenic pulmonary oedema: Analysis from the 3CPO trial. QJM 2010; 103(8):573-81. Medline
|
|
II
|
Opposes (Red)
|
1) CHF diagnosis 2) BNP level 3) Death
|
Patient
|
PH-Paramedic
|
Jaronik J., Mikkelson P., Fales W., Overton D. Evaluation of prehospital use of furosemide in patients with respiratory distress. Prehosp Emerg Care 2006; 10(2):194-7. Medline
|
|
III
|
Supportive (Green)
|
Adverse Events
|
Patient
|
PH-Paramedic
|
Pan A., Stiell IG., Dionne R., Maloney J. Prehospital use of furosemide for the treatment of heart failure. Emerg Med J 2015; 32(1):36-43. Medline
|
|
III
|
Neutral (Yellow)
|
Improvement in vital signs
|
Patient
|
PH-Paramedic
|
Sporer KA., et al. Do medications affect vital signs in the prehospital treatment of acute decompensated heart failure? Prehosp Emer Care 2006; 10:41-5. Medline
|
|
III
|
Neutral (Yellow)
|
Survival, Length of stay
|
Patient
|
PH-Paramedic
|
Wuerz RC., Meador SA. Effects of prehospital medications on mortality and length of stay in congestive heart failure. Ann Emerg Med 1992; 21(6):669-674. Medline
|
NiPPV
| Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
|
I
|
Supportive (Green)
|
Hospital mortality
|
Patient
|
ED-MD
|
Collins SP., Mielniczuk LM., Whittingham HA., Boseley ME., Schramm DR., Storrow AB. The use of noninvasive ventilation in emergency department patients with acute cardiogenic pulmonary edema: a systematic review. Ann Emerg Med 2006; 48(3):260-9. Medline
|
|
I
|
Supportive (Green)
|
Death within 7 days
|
Patient
|
ED-MD
|
Gray A., et al. Noninvasive ventilation in acute cardiogenic pulmonary edema. NEJM 2008; 359:142-51. Medline
|
|
I
|
Supportive (Green)
|
Inhospital mortality
|
Patient
|
PH-Paramedic
|
Mal S., McLeod S., Iansavichene A., Dukelow A., Lewell M. Effect of out-of-hospital noninvasive positive-pressure support ventilation in adult patients with severe respiratory distress: A systematic review and meta-analysis. Ann Emerg Med 2014; 63(5):600-7. Medline
|
|
I
|
Supportive (Green)
|
Mortality
|
Patient
|
ED-MD
|
Masip J., Roque M., Sanchez B., Fernadez R., Subirana M., Exposito JA. Noninvasive ventilation in acute cardiogenic pulmonary edema. JAMA 2005; 294:3124-30. Medline
|
|
I
|
Supportive (Green)
|
Combined criterion of ETI, death, or MI in first 24h
|
Patient
|
ED-MD
|
Moritz F., Brousse B., Gellee B., et al. Continuous positive airway pressure versus bilevel noninvasive ventilation in acute cardiogenic pulmonary edema: A randomized multicenter trial. Ann Emerg Med 2007; 50(6):666-75. Medline
|
|
I
|
Supportive (Green)
|
need for endotracheal intubation
|
Patient
|
ED-MD
|
Nava S., Carbone G., DiBattista N., et al. Noninvasive ventilation in cardiogenic pulmonary edema: A multicenter randomized trial. Am J Respir Crit Care Med 2003; 168(12):1432-7. Medline
|
|
I
|
Supportive (Green)
|
Mortality
|
Patient
|
PH-Paramedic
|
Park M., et al. Randomized, prospective trial of oxygen, continuous positive airway pressure, and bi-level positive airway pressure by face mask in acute cardiogenic pulmonary edema. Crit Care Med 2004; 32:2407-15. Medline
|
|
I
|
Supportive (Green)
|
Mortality
|
Patient
|
ED-MD
|
Peter JV., et al. Effect of noninvasive positive-pressure ventilation on mortality in patients with acute pulmonary oedema: a meta-analysis. The Lancet 2006; 367:1155-63. 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
|
Supportive (Green)
|
Oxygen saturation
|
Patient
|
PH-Paramedic
|
Weitz G., Struck J., Zonak A., Balnus S., Perras B., Dodt C. Prehospital noninvasive pressure support ventilation for acute cardiogenic pulmonary edema. Eur J Emerg Med 2007; 14(5):276-279. Medline
|
|
I
|
Supportive (Green)
|
Mortality, Intubation
|
Patient
|
PH-Paramedic
|
Williams TA., Finn J., Perkins GD., Jacobs IG. Prehospital continuous positive airway pressure for acute respiratory failure: a systematic review and meta-analysis. Prehosp Emerg Care 2013; 17(2):261-273. Medline
|
|
I
|
Neutral (Yellow)
|
Placement detection
|
Process
|
|
Frontin P., Bounes V., Houze-Cerfon CH., Charpentier S., Houze-Cerfon V., Ducasse JL. Continuous positive airway pressure for cardiogenic pulmonary edema: A randomized study. Am J Emerg Med 2011; 29(7):775-81. Medline
|
|
I
|
Neutral (Yellow)
|
7-day mortality
|
Patient
|
ED-MD
|
Gray AJ., Goodacre S., Newby DE., Masson MA., Sampson F., Dixon S., et al. A multicentre randomised controlled trial of the use of continuous positive airway pressure and non-invasive positive pressure ventilation in the early treatment of patients presenting to the emergency department with severe acute cardiogenic pulmonary oedema: the 3CPO trial. Health Technol Assess 2009; 13(33):1-106. Medline
|
|
I
|
Neutral (Yellow)
|
Hospital death and ETI
|
Patient
|
ED-MD
|
Nouira S., Boukef R., Bouida W., Kerkeni W., Beltaief K., Boubaker H., et al. Non-invasive pressure support ventilation and CPAP in cardiogenic pulmonary edema: a multicenter randomized study in the emergency department. Intensive Care Med 2011; 37(2):249-56. 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)
|
Oxygen Saturation, Intubation
|
Process
|
PH-Paramedic
|
Craven RA., Singletary N., Bosken L., et al. Use of bilevel positive airway pressure in out-of-hospital patients. Acad Emerg Med 2000; 7(9):1065-8. Medline
|
|
II
|
Supportive (Green)
|
Effectiveness of NiPPV in CHF
|
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)
|
Prehospital endotracheal intubation rate
|
Process
|
PH-Paramedic & MD
|
Gartner BA., Fehlmann C., Suppan L., Niquille M., Rutschmann OT., Sarasin F. Effect of noninvasive ventilation on intubation risk in prehospital patients with acute cardiogenic pulmonary edema: a retrospective study. European journal of emergency medicine 2019. Medline
|
|
II
|
Supportive (Green)
|
Adherence to treatment
|
Process
|
PH-Paramedic
|
Nielsen VM., Madsen J., Aasen A., Toft-Petersen AP., Lubcke K., Rasmussen BS., et al. Prehospital treatment with continuous positive airway pressure in patients with acute respiratory failure: a regional observational study. Scand J Trauma Resusc Emerg Med 2016; 24(1):121. Medline
|
|
II
|
Supportive (Green)
|
Mortality
|
Patient
|
ED-MD
|
Pagano A, Numis FG, Rosato V, Russo T, Porta G, Bosso G, et al. Pressure support ventilation vs Continuous positive airway pressure for treating of acute cardiogenic pulmonary edema: A pilot study. Respiratory physiology & neurobiology 2018; 255:7-10. Medline
|
|
II
|
Supportive (Green)
|
SpO2, RR
|
Patient
|
|
Sahu N, Matthews P, Groner K, Papas MA, Megargel R. Observational Study on Safety of Prehospital BLS CPAP in Dyspnea. Prehosp Disaster Med 2017; 32(6):610-4. Medline
|
|
II
|
Supportive (Green)
|
NPPV in Pulmonary Oedema
|
Process
|
Other
|
Seiler C, Kristiansson L, Klingberg C, Sundh J, Braman Eriksson A, Lundeqvist D, et al. Swimming-Induced Pulmonary Edema: Evaluation of Prehospital Treatment With CPAP or Positive Expiratory Pressure Device. Chest 2022. 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)
|
Mortality
|
Patient
|
|
Gardtman M., Waagstein L., Karlsson T., Herlitz J. Has an intensified treatment in the ambulance of patients with acute severe left heart failure improved the outcomes? European Journal of Emer Med 2000; 7:15-24. Medline
|
|
II
|
Neutral (Yellow)
|
Adverse events including death
|
Patient
|
PH-Paramedic
|
Sharon A., Shpirer I., Kaluski E., Moshkovitz Y., Milovanov O., Polak R., et al. High-dose intravenous isosorbide-dinitrate is safer and better than Bi-PAP ventilation combined with conventional treatment for severe pulmonary edema. JAC 2000; 36(3):832–7. 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)
|
Cost effectiveness
|
Process
|
PH-Paramedic
|
Hubble MW., Richards ME., Wilfong DA. Estimates of cost-effectiveness of prehospital CPAP in the management of acute pulmonary edema. Prehosp Emerg Care 2008; 12:277-85. Medline
|
|
III
|
Supportive (Green)
|
Feasibility
|
Patient
|
PH-Paramedic
|
Kosowsky JM., Stephanides SL., Branson RD., Sayre MR. Prehospital use of CPAP for presumed pulmonary edema: a preliminary case series. Prehospital Emer Care 2001; 5:190-6. Medline
|
|
III
|
Supportive (Green)
|
Feasibility
|
Process
|
ED-MD
|
Pollack CV., Torres MT., Alexander L. Feasibility study of the use of bi-level positive airway pressure for respiratory support in the emergency department. Ann Emerg Med 1996; 27:18-92. Medline
|
|
III
|
Supportive (Green)
|
avoidance of ETI
|
Patient
|
ED-MD
|
Sacchetti AD., Harris RH., Paston C., Hernandez Z. Bi-level positive airway pressure support system use in acute congestive heart failure: Preliminary case series. Acad Emerg Med 1995; 2(8):714-8. Medline
|
|
III
|
Supportive (Green)
|
Number of B lines
|
Process
|
|
Strnad M., Prosen G., Borovnik Lesjak V. Bedside lung ultrasound for monitoring the effectiveness of prehospital treatment with continuous positive airway pressure in acute decompensated heart failure. Eur J Emerg Med 2016; 23(1):50-55. Medline
|
|
III
|
Supportive (Green)
|
Oxygenation
|
Patient
|
PH-Paramedic
|
Tarja K, et al. The Use of Prehospital Continuous Positive Airway Pressure Treatment of Presumed Acute Severe Pulmonary Edema. PEC 2003; 7(2):209-13. Medline
|
|
III
|
Supportive (Green)
|
Effectiveness
|
Patient
|
ED-MD
|
Widger HN., Hoffman P., Mazzolini D., Stone A., Scholly S., Clark J. Pressure support noninvasive positive pressure ventilation treatment of acute cardiogenic pulmonary edema Am J Emerg Med 2001; 19(3):179-81. Medline
|
|
III
|
Neutral (Yellow)
|
Number of patients who could benefit from NiPPV
|
Patient
|
PH-Paramedic
|
Taylor DM., Bernard SA., Masci K., MacBean CE., Kennedy MP. Prehospital noninvasive ventilation: A viable treatment option in the urban setting. Prehosp Emer Care 2008; 12:42-5. Medline
|
|
III
|
Opposes (Red)
|
Need for intubation
|
Patient
|
ED-MD
|
Yosefy C., Hay E., Ben-Barak A., Derazon H., Magen E., Reisin L., et al. BiPAP ventilation as assistance for patients presenting with respiratory distress in the department of emergency medicine. Am J Respir Med 2003; 2(4):343-347. Medline
|
|
X
|
Not Yet Graded (White)
|
-
|
|
|
Marjanovic N, Piton M, Lamarre J, et al. High-flow nasal cannula oxygen versus noninvasive ventilation for the management of acute cardiogenic pulmonary edema: a randomized controlled pilot study. Eur J Emerg Med Aug 2024; 31(4):267-75. Medline
|