Pulmonary edema in the prehospital setting: the importance of early treatment

Abstract

Introduction: Patients with acute cardiogenic pulmonary edema require rapid assessment and therapy to prevent progression to respiratory failure and cardiovascular collapse. Lisbon city has emergency medical teams that respond to situations where the life of the patient is at risk and whose goal is to begin treatment if indicated and assure transport to the hospital in the best conditions possible. We studied the intervention of one of these teams on patients with acute pulmonary edema. Method(s): Medical records of the activity of our prehospital emergency vehicle from April 2005 to October 2009 were analyzed. All records of patients having a clinical diagnosis of acute pulmonary edema at the scene were considered. Incomplete records were excluded. Result(s): In the 55 months considered our emergency vehicle attended 9,856 calls, from which 493 (5%) were for acute pulmonary edema. Patients ages range from 20 to 99 years, with a mean age of 75.8 years, and 47.8% were males. A total of 58.6% of calls were made on the night period (from 8 pm to 8 am), most between 8 pm and 0 pm. Risk factors included arterial hypertension (62.3%), ischemic heart disease (43.2%), diabetes mellitus (31.8%), heart failure (23.3%), atrial fibrillation (13.2%) and renal failure (9.9%). On arrival of the prehospital medical team at the scene, 24 patients (4.9%) required immediate intubation and five evolved to cardiac arrest, four of whom were successfully resuscitated and transported to hospital. Conclusion(s): Our prehospital medical teams attended a large number of patients with pulmonary edema during this period. We recorded a small number of patients requiring mechanical intubation and a high rate of survival on those suffering from cardiac arrest in this context. We believe this is largely because of the decreased response time that prehospital emergency offers in this situation, allowing the institution of early treatment.