Prehospital and Disaster Medicine

Comprehensive Review

When Pressure is Positive: A Literature Review of the Prehospital Use of Continuous Positive Airway Pressure

Brett Williamsa1 c1, Malcolm Boylea1, Nicole Robertsona1 and Coco Giddingsa1

a1 Department of Community Emergency Health and Paramedic Practice, School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University – Peninsula Campus, Frankston, Victoria, Australia


Background Heart failure poses a significant burden of disease, resulting in 2,658 Australian deaths in 2008, and listed as an associated cause of death in a further 14,466 cases. Common in the hospital setting, continuous positive airway pressure (CPAP) therapy is a non-invasive ventilation technique used to prevent airway collapse and manage acute pulmonary edema (APO). In the hospital setting, CPAP has been known to decrease the need for endotracheal intubation in patients with APO. Therefore the objective of this literature review was to identify the effectiveness of CPAP therapy in the prehospital environment.

Methods A review of selected electronic medical databases (Cochrane, Medline, EMBASE, and CINAHL) was conducted from their commencement date through the end of May 2012. Inclusion criterion was any study type reporting the use of CPAP therapy in the prehospital environment, specifically in the treatment of heart failure and acute pulmonary edema. References of relevant articles were also reviewed.

Results The literature search located 1,253 articles, 12 of which met the inclusion criteria. The majority of studies found that the use of CPAP therapy in the prehospital environment is associated with reduced short-term mortality as well as reduced rates of endotracheal intubation. Continuous positive airway pressure therapy was also shown to improve patient vital signs during prehospital transport and reduce myocardial damage.

Discussion The studies conducted of prehospital use of CPAP to manage APO have all demonstrated improvement in patient outcomes in the short term.

Conclusion Available evidence suggests that the use of CPAP therapy in the prehospital environment may be beneficial to patients with acute pulmonary edema as it can potentially decrease the need for endotracheal intubation, improve vital signs during transport to hospital, and improve short-term mortality.

B Williams, M Boyle, N Robertson, C Giddings. When pressure is positive: a literature review of the prehospital use of continuous positive airway pressure. Prehosp Disaster Med. 2013;28(1):1-10.

(Received August 30 2011)

(Revised June 18 2012)

(Accepted September 22 2012)

(Online publication November 09 2012)


  • acute pulmonary edema;
  • CPAP;
  • emergency care;
  • paramedic;
  • prehospital


  • APO:acute pulmonary edema [oedema];
  • CPAP:continuous positive airway pressure;
  • COPD:chronic obstructive pulmonary disease;
  • ETI:endotracheal intubation


c1 Correspondence: Brett Williams, PhD Department of Community Emergency Health and Paramedic Practice Monash University Building H McMahons Road Frankston 3199 Victoria, Australia E-mail


  Conflicts of interest: The authors have no conflicts of interest to declare.