3CPO trial-non-invasive ventilation effect-Heart failure - HOTLINE 1 

This multicentre randomised controlled trial of the early management of patients with acute cardiogenic pulmonary oedema (the 3CPO study) compared two intervention arms (continuous positive airways pressure [CPAP] and non-invasive intermittent positive pressure ventilation [NIPPV]) with standard oxygen therapy. 1069 patients (mean age 78 years; 43% male) were recruited into the trial and were randomised to standard oxygen therapy (n=367), CPAP (n=346; 10±4 cmH2O) or NIPPV (356; 14±5/7±2 cmH2O).

At entry, patients were tachycardic (heart rate 113±22 /min), acidotic (pH 7.25±0.11), tachypneic (respiratory rate 32±7 /min) and hypoxic (oxygen saturation 90±8%). In comparison to standard oxygen therapy, non-invasive ventilation was associated with greater improvements in tachycardia (102±23 versus 96±22 /min, P<0.001), acidosis (pH 7.33±0.11 versus 7.36±0.11, P=0.002) and tachypnea (26±6 versus 25±6, P=0.023) at one hour.

The 7-day and 30-day mortality was similar for standard oxygen therapy and non-invasive ventilation (9.8% versus 9.5% (p=0.869) and 16.6% versus 15.6% (p=0.685) respectively). The combined end-point of 7-day death or intubation rate was similar for both forms of non-invasive ventilation (11.7% versus 11.1%, CPAP versus NIPPV; P=0.806). There was a high rate of acute myocardial infarction (~50%) that was similar in all three groups. Conclusion In patients with acute cardiogenic pulmonary edema, non-invasive ventilation induces a more rapid improvement in respiratory distress and metabolic disturbance with both CPAP and NIPPV appearing to be equally efficacious. However, non-invasive ventilation has no major effect on short-term mortality.

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