Is the Administration of CPAP without Paramedic-Level Intervention Associated with Decreased Hospital Length of Stay?
Author: Chip Munna | |
Associate Authors: Bryant Reid |
Ginny K. Renkiewicz
Introduction
Respiratory complaints are common in out-of-hospital call responses. Despite the inclusion of continuous positive airway pressure (CPAP) in the 2018 National EMS Scope of Practice Model as an EMT-level skill, the utilization of CPAP by EMTs varies greatly by state, region, and agency. Little is known regarding outcomes of EMS patients treated with CPAP without additional advanced life-support (ALS) interventions.
Objective
To compare hospital length of stay between patients receiving CPAP treatment with and without additional ALS respiratory medications.
Methods
Using the ESO Data Collaborative research data set with records from January 1 to December 31, 2020, we conducted a retrospective analysis of patients over 18 years of age with primary or secondary impressions of respiratory conditions that received CPAP treatment in the prehospital setting. Dichotomous dummy variables were created for two patient groups: (1) received CPAP with or without additional basic life support (BLS)-level respiratory medications, which included albuterol or levalbuterol; and (2) received CPAP with an additional ALS-level respiratory medication (i.e., furosemide, ipratropium bromide, methylprednisolone, etc.). A Mann-Whitney U-test was conducted to determine differences in hospital length of stay (in days) between the two groups.
Results
A total of 4111 patients met inclusion criteria. Overall, the median length of stay was 4.0 (IQR: 2.0-8.0) days in the hospital. The median length of stay for patients who received only BLS respiratory care was 4.0 (IQR: 2.0-7.0) days, while the median length of stay for patients who received ALS respiratory care was 5.0 (IQR: 3.0-9.06.0) days. When compared to patients receiving ALS-level respiratory care to those who received only BLS respiratory care, a Mann-Whitney U-test showed a significant difference between the two groups (U = 1,504,458 days; P < 0.001); however, the effect size of 0.08 was negligible.
Conclusions
Patients who received CPAP with BLS care experienced slightly shorter lengths of stay compared to patients who received CPAP and ALS medications. It is plausible that patients who received ALS medications had more serious illnesses that affected length of stay. Additional research should be conducted to standardize patient acuity to determine the true effect of BLS-only level of care for prehospital respiratory patients.
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