# Utilization of Continuous Positive Airway Pressure (CPAP) by Emergency Medical Services: Updated Systematic Review and Meta-analysis

## TL;DR

This study updates the evidence on whether using CPAP in emergencies helps patients with breathing problems.

## Contribution

An updated systematic review and meta-analysis of prehospital CPAP effectiveness in respiratory failure patients.

## Key findings

- No significant difference in in-hospital mortality between CPAP and standard care groups.
- Newer studies showed increased risk ratios for CPAP, suggesting possible changing efficacy over time.
- The analysis included 747 CPAP patients and 713 standard care patients across four studies.

## Abstract

Background: While new studies are being published on the prehospital continuous
positive airway pressure (CPAP) application in patients with respiratory failure
with conflicting results, previous meta-analyses are showing the benefits of
CPAP in the prehospital transfer of patients with respiratory distress. Before
the clinical application of high-level evidence, updated pooled estimates are
needed based on the growing literature. This study aimed to compare prehospital
CPAP with the usual standard oxygen therapy of respiratory failure patients.
Materials and Methods: PRISMA guidelines served as the framework for this
updated review study. It is an extension of a prior systematic review. We
conducted comprehensive searches across several databases, including PubMed, Web
of Science, Embase, and Scopus, focusing on randomized trials that juxtaposed
pre-hospital CPAP application against standard care. Our primary interest was to
assess the in-hospital mortality risks, and we employed random effect models to
aggregate risk ratios from the selected studies. Results: Four articles were
gathered based on the review of the updated literature (2013 to November 2022)
in conjunction with the research incorporated in the preceding meta-analysis
with a total number of 747 patients receiving prehospital CPAP with 101 events
of in-hospital mortality. In the standard treatment control groups, there were
713 patients and 115 deaths occurred. Pooled mortality risk comparison between
the group of prehospital CPAP and standard care patients had no statistically
significant difference (P=0.16). There was no heterogenicity. A regression
between the year of the studies and the effect size showed increased RR in new
studies (P=0.017). Conclusion: Still more randomized trials are needed with
higher sample sizes to conclude the lifesaving efficacy of the out-of-hospital
CPAP.