Vital COVID-19 study carried out at Eastern hospitals finds CPAP reduces need for invasive ventilation in hospitalised patients

Results from the Respiratory Strategies in COVID-19; continuous positive airway pressure (CPAP), High-flow, and Standard Care (RECOVERY-RS) trial, published today, reveal that treating hospitalised COVID-19 patients who have acute respiratory failure with continuous positive airway pressure (CPAP) reduces the need for invasive mechanical ventilation.

The study, funded by the National Institute for Health Research (NIHR), opened in April 2020 and was carried out at NHS trusts across the country, with several hospitals in the region recruiting participants to it. These include:

• East Suffolk and North Essex NHS Foundation Trust
• East and North Hertfordshire NHS Trust
• James Paget University Hospitals NHS Foundation Trust
• Norfolk and Norwich University Hospitals NHS Foundation Trust

A total of 1,272 patients aged 18 or over who were hospitalised with acute respiratory failure were recruited to the randomised controlled trial study, including 18 at Eastern hospitals. Participants were randomly allocated to receive either CPAP (oxygen and positive pressure delivered via a tightly fitting mask), with HFNO (high pressure oxygen delivered up the nose) or standard oxygen therapy as part of their hospital care.

All three interventions have been commonly used to treat COVID-19 patients before they are moved onto invasive ventilation in a critical care bed, but it was not known which, if any, resulted in better outcomes. Results show that 36.3% of patients treated with CPAP went on to require invasive mechanical ventilation or died within 30-days of treatment compared to 44.4% in the conventional oxygen therapy group.

Preliminary data from the trial also suggests that the routine use of high flow nasal oxygenation (HFNO), which can consume large amounts of oxygen, should be reconsidered as it did not improve outcomes for COVID-19 patients compared with conventional oxygen therapy.

Helen Macdonald, Chief Operating Officer for the NIHR Clinical Research Network Eastern, said:

"We are incredibly proud of all our colleagues across the region who have demonstrated unwavering dedication throughout the pandemic to deliver this and all other vital COVID-19 research. None of this would have been possible without the generosity of participants who volunteer to take part in research and we are immensely grateful to all.

“The results of the RECOVERY-RS trial add to the growing body of research that continues to give us the breakthroughs needed to help care for patients. We remain steadfast in supporting research happening across East Anglia to find treatments, vaccines and ways to care for people with COVID and all conditions, where it's most needed."

RECOVERY-RS, led by the University of Warwick and Queen’s University Belfast, is the world’s largest non-invasive respiratory support trial for COVID-19.