Helmet continuous positive airway pressure vs. high flow nasal cannula oxygen in acute cardiogenic pulmonary oedema: a randomized controlled trial

Osman A 1 , Via G 2 , Sallehuddin RM 1 , Ahmad AH 1 , Fei SK 3 , Azil A 1 Show all authors , Mojoli F 4 , Fong CP 1 , Tavazzi G 4

Affiliations 

  • 1 Resuscitation & Emergency Critical Care Unit, Trauma and Emergency Department, Raja Permaisuri Bainun Hospital, Ipoh, Perak, Malaysia
  • 2 Department of Anesthesia and intensive care, Cardiac Anesthesia & Intensive Care-Istituto Cardiocentro Ticino, Lugano, Switzerland
  • 3 Trauma and Emergency Department, Penang General Hospital, Jalan Residensi, George Town, Penang, Malaysia
  • 4 Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, DEA Piano -1, Fondazione IRCCS Policlinico S. Matteo, Viale Golgi 19, 27100 Pavia, Italy
Eur Heart J Acute Cardiovasc Care, 2021 Dec 18;10(10):1103-1111.
PMID: 34632507 DOI: 10.1093/ehjacc/zuab078

Abstract

AIMS : Non-invasive ventilation represents an established treatment for acute cardiogenic pulmonary oedema (ACPO) although no data regarding the best ventilatory strategy are available. We aimed to compare the effectiveness of helmet CPAP (hCPAP) and high flow nasal cannula (HFNC) in the early treatment of ACPO.

METHODS AND RESULTS : Single-centre randomized controlled trial of patients admitted to the emergency department due to ACPO with hypoxemia and dyspnoea on face mask oxygen therapy. Patients were randomly assigned with a 1:1 ratio to receive hCPAP or HFNC and FiO2 set to achieve an arterial oxygen saturation >94%. The primary outcome was a reduction in respiratory rate; secondary outcomes included changes in heart rate, PaO2/FiO2 ratio, Heart rate, Acidosis, Consciousness, Oxygenation, and Respiratory rate (HACOR) score, Dyspnoea Scale, and intubation rate. Data were collected before hCPAP/HFNC placement and after 1 h of treatment. Amongst 188 patients randomized, hCPAP was more effective than HFNC in reducing respiratory rate [-12 (95% CI; 11-13) vs. -9 (95% CI; 8-10), P 

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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