Tricia Rotter, Robert J. Tubbs, Jonathan Valente, Robert Partridge

Department Of Emergency Medicine, Rhode Island Hospital/brown Medical School, Ir, Usa.

Keywords: Bi-level positive airway pressure, heart failure, intubation; medical therapy.


OBJECTIVE: Previous studies indicate that bi-level positive airway pressure (BiPAP) for congestive heart failure (CHF) may increase the rate of myocardial infarction (AMI). We compare rates of AMI and death in patients receiving medical therapy, BiPAP or intubation for CHF in the emergency department (ED). Methods: Retrospective chart review of ED patients with CHF over 2 years.
RESULTS: 745 subjects were enrolled. 553 (74.2%) received medical therapy alone; 158 (21.2%) received BiPAP and medical therapy; 34 patients (4.6%) were intubated in the ED. Patients receiving medical therapy alone had an AMI rate of 6.2%, compared with 15.8% of patients on BiPAP, and 32.4% of intubated patients (p<0.0001). Death rate in patients treated with medical therapy alone was 2.4%, compared with 8.2% of patients on BiPAP, and 20.6% of intubated patients (p<0.0001). CONCLUSION: ED patients treated with Bi-PAP for CHF have lower rates of AMI than intubated patients. Patients receiving medical therapy only had the lowest rates of AMI and mortality.