Mortality in acute cardiogenic pulmonary edema treated with continuous positive airway pressure

OBJECTIVE: To investigate mortality in acute cardiogenic pulmonary edema (ACPE) patients treated with continuous positive airway pressure (CPAP) and to identify clinical and laboratory characteristics associated with mortality. DESIGN: Observational, retrospective study. SETTING: Emergency Medicine Department. PATIENTS AND PARTICIPANTS: A total of 454 consecutive ACPE patients treated with CPAP. MEASUREMENTS AND RESULTS: Demographics, past medical history, clinical characteristics, laboratory evaluation, in-hospital mortality data were collected. Potential predictors of in-hospital mortality that were considered of clinical relevance and immediately accessible on admission were investigated by multivariable logistic regression. ACPE-related mortality rate was 3.8% (17/452 patients) and the in-hospital mortality rate was 11.4% (50/440 patients). Significant independent predictors of increased risk of in-hospital mortality were: advanced age (P = 0.012), normal-to-low blood pressure (P < 0.001), low PaO(2)/FiO(2) ratio (P = 0.020), hypocapnia (P = 0.009) and anemia (P = 0.05). CONCLUSIONS: Values recorded within few minutes from arrival to the hospital can predict mortality in ACPE patients treated with CPAP who has been tested, for the first time, in a real life study. This can allow physicians to quickly recognize more severe ACPE patients treated with CPAP and plan for aggressive monitoring and treatment and for deciding the better site of care.