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Early out-of-hospital non-invasive ventilation is superior to standard medical treatment in patients with acute respiratory failure: a pilot study
  1. Markus Sören Roessler1,
  2. Dorothee Susanne Schmid1,
  3. Peter Michels1,
  4. Oliver Schmid1,
  5. Klaus Jung2,
  6. Jörg Stöber3,
  7. Peter Neumann4,
  8. Michael Quintel1,
  9. Onnen Moerer1
  1. 1Department of Anaesthesiology, Emergency and Intensive Care Medicine, University Medicine, Georg-August-University, Goettingen, Germany
  2. 2Department of Medical Statistics, Georg-August-University, Goettingen, Germany
  3. 3Emergency Medical Services, Fire Brigade, Goettingen, Germany
  4. 4Department of Clinical Anaesthesiology and Intensive Care Medicine, Evangelisches Krankenhaus Goettingen Weende e.V., Goettingen, Germany
  1. Correspondence to Markus Sören Roessler, Department of Anaesthesiology, Emergency- and Intensive Care Medicine, University Medicine, Georg-August-University Goettingen, Germany, Robert-Koch-Strasse 40, 37075 Goettingen, Germany; m.roessler{at}


Objective To assess in patients with acute respiratory failure (ARF) whether out-of-hospital (OOH) non-invasive ventilation (NIV) is feasible, safe and more effective compared with standard medical therapy (SMT).

Patients and Interventions Patients with OOH ARF were randomly assigned to receive either SMT or NIV.

Measurements and Results Fifty-one patients were enrolled, 26 of whom were randomly assigned to SMT and 25 of whom received NIV. Two patients were excluded because of protocol violations. OOH NIV was safe and effective in all patients. In the SMT group, treatment was not effective in five of 25 patients who required OOH mechanical ventilation (p=0.05). Patients in the SMT group were admitted to an intensive care unit (ICU) more frequently (n=17) (p<0.05) and for longer periods (3.7±6.4 days) (p=0.03) compared with patients in the NIV group (n=9, 1.3±2.6 days). Six patients in the SMT group required subsequent inhospital intubation and invasive ventilation during their hospital stays; only one patient in the NIV group required intubation (p=0.10). In contrast, patients in the NIV group received NIV more frequently (n=14) in hospital compared with patients in the SMT group (n=5) (p<0.01).

Conclusions OOH NIV proved to be feasible, safe and more effective for the treatment of ARF compared with SMT. OOH NIV promotes inhospital treatment with NIV and may reduce the frequency and length of ICU stays. Because the risks of OOH emergency intubation can be avoided, NIV should be the first-line treatment in OOH ARF if no contraindications are present.

  • Acute cardiogenic pulmonary oedema
  • acute respiratory failure
  • chronic obstructive pulmonary disease
  • emergency ambulance systems
  • intensive care
  • non-invasive ventilation
  • nursing
  • out-of-hospital
  • pre-hospital
  • respiratory

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  • Competing interests None declared.

  • Ethics approval This study was conducted with the approval of the ethics committee of the Georg-August-University, Goettingen.

  • Provenance and peer review Not commissioned; externally peer reviewed.