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Practical use, effects and complications of prehospital treatment of acute cardiogenic pulmonary edema using the Boussignac CPAP system

Eva Eiske Spijker12*, Maarten de Bont3, Matthijs Bax4 and Maro Sandel5

Author Affiliations

1 Emergency Department, Haga Hospital, Leiden University, The Hague, The Netherlands

2 Present: Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands

3 Emergency Department, Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands

4 Cardiology Department, Haga Hospital The Hague, 275, 2545 CH The Hague, The Netherlands

5 Emergency Department, Haga Hospital The Hague, Leyweg 275, 2545 CH, The Hague, The Netherlands

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International Journal of Emergency Medicine 2013, 6:8  doi:10.1186/1865-1380-6-8

Published: 8 April 2013



Early use of continuous positive airway pressure (CPAP) has been shown to be beneficial within the setting of acute cardiogenic pulmonary edema (ACPE). The Boussignac CPAP system (BCPAP) was therefore introduced into the protocols of emergency medical services (EMS) in a large urban region. This study evaluates the implementation, practical use and complications of this prehospital treatment.


This was a retrospective case series study. The study was carried out in a period shortly after the implementation of the BCPAP system on all EMS ambulances in the The Hague region. According to protocol, diagnosis of ACPE in the prehospital setting was left to the discretion of the EMS paramedics and the facial mask was applied immediately after the diagnosis had been made. Patients were selected through hospital registration and diagnostic criteria for ACPE. Only those patients showing evident clinical signs of ACPE were included. Patient characteristics, physiologic variables, clinical outcomes and complications were collected from EMS transport reports and hospital records.


Between 1 June 2008 and 30 April 2009 a total of 180 patients were admitted for ACPE. Of these, 76 (42%) had evident clinical signs of ACPE upon presentation and were included. Three patients were transferred and in 14 cases data were missing. Out of the remaining 59 patients, 16 (27%) received BCPAP. In 43 (73%) cases the mask was not applied. For 7 out of 43 cases that were eligible for BCPAP treatment but did not receive the facial mask, an explanation was found in the EMS transport record. No complications were recorded pertaining to using the BCPAP system.


A significant portion of patients with clinical signs of acute cardiogenic pulmonary edema in the prehospital setting is not treated according to protocol using BCPAP. Based on the small group of patients that actually received BCPAP treatment, the facial mask seems feasible and effective for the treatment of acute cardiogenic pulmonary edema in the prehospital setting.

Non-invasive ventilation; Continuous positive airway pressure (CPAP) ventilation; Boussignac mask; Acute heart failure; Acute cardiogenic pulmonary edema; Prehospital emergency care