Cliff Reid has already mentioned this paper, but I’m just getting to it so here’s my thoughts.
This is an RCT of clinically diagnosed APO (pulmonary oedema) in the field by “mobile ICUs” of France. They have the highest ranked health care system in the world BTW. Their pre-hospital system is physician staffed and so that makes it markedly different from a lot of other places.
Randomised to either valve CPAP (not ventilator CPAP) at 10cm H20 vs O2. Everyone got a moderate dose of frusejuice (1mg/kg) and some nitrates. I confess I don’t know if 2mg/hr of Isosorbide Dinitrate is high or low, we use GTN…
Their outcome was unfortunately a mixture of (still important) physiologic parameters and not something like mortality.
They found no real difference.
This doesn’t mean it’s not a good idea, it’s always going to be difficult to prove real benefit with these numbers and these outcomes. Especially when it’s in a system contextually different from ours.
Frontin, Philippe, Vincent Bounes, Charles Henri Houzé-Cerfon, Sandrine Charpentier, Vanessa Houzé-Cerfon, and Jean Louis Ducassé. “Continuous positive airway pressure for cardiogenic pulmonary edema: a randomized study..” The American Journal of Emergency Medicine 29, no. 7 (September 2011): 775–781. PMID 20825901