Sympathetic crashing acute pulmonary edema (SCAPE) is the extreme end of the spectrum of acute pulmonary edema. It is important to understand this disease as it is relatively common in the emergency department (ED) and has better outcomes when managed appropriately. The patients have an abrupt redistribution of fluid in the lungs, and when treated promptly and effectively, these patients will rapidly recover. Noninvasive ventilation and intravenous nitrates are the mainstay of treatment which should be started within minutes of the patient′s arrival to the ED. Use of morphine and intravenous loop diuretics, although popular, has poor scientific evidence.
Fromm RE Jr., Varon J, Gibbs LR. Congestive heart failure and pulmonary edema for the emergency physician. J Emerg Med 1995;13:71-87.
Howlett JG. Current treatment options for early management in acute decompensated heart failure. Can J Cardiol 2008;24 Suppl B: 9B-14B.
Weingart S. Emcrit Podcast 1, Sympathetic Crashing Acute Pulmonary Edema. Available from: http://www.emcrit.org. [Last accessed on 2016 Oct 30].
Mebazaa A, Gheorghiade M, Piña IL, Harjola VP, Hollenberg SM, Follath F, et al. Practical recommendations for prehospital and early in-hospital management of patients presenting with acute heart failure syndromes. Crit Care Med 2008;36 1 Suppl:S129-39.
Sartori C, Allemann Y, Scherrer U. Pathogenesis of pulmonary edema: Learning from high-altitude pulmonary edema. Respir Physiol Neurobiol 2007;159:338-49.
Ware LB, Matthay MA. Clinical practice. Acute pulmonary edema. N Engl J Med 2005;353:2788-96.
West JB, Mathieu-Costello O. Stress failure of pulmonary capillaries in the intensive care setting. Schweiz Med Wochenschr 1992;122:751-7.
Lenders JW, Eisenhofer G, Mannelli M, Pacak K. Phaeochromocytoma. Lancet 2005;366:665-75.
Yamanaka O, Yasumasa F, Nakamura T, Ohno A, Endo Y, Yoshimi K, et al. "Myocardial stunning"- like phenomenon during a crisis of pheochromocytoma. Jpn Circ J 1994;58:737-42.
Rimoldi SF, Yuzefpolskaya M, Allemann Y, Messerli F. Flash pulmonary edema. Prog Cardiovasc Dis 2009;52:249-59.
Krasney JA. A neurogenic basis for acute altitude illness. Med Sci Sports Exerc 1994;26:195-208.
Hopkins SR, Gavin TP, Siafakas NM, Haseler LJ, Olfert IM, Wagner H, et al. Effect of prolonged, heavy exercise on pulmonary gas exchange in athletes. J Appl Physiol 1998;85:1523-32.
Kramer K, Kirkman P, Kitzman D, Little WC. Flash pulmonary edema: Association with hypertension and reoccurrence despite coronary revascularization. Am Heart J 2000;140:451-5.
Gandhi SK, Powers JC, Nomeir AM, Fowle K, Kitzman DW, Rankin KM, et al. The pathogenesis of acute pulmonary edema associated with hypertension. N Engl J Med 2001;344:17-22.
Missov E, Calzolari C, Pau B. Circulating cardiac troponin I in severe congestive heart failure. Circulation 1997;96:2953-8.
Perna ER, Macín SM, Parras JI, Pantich R, Farías EF, Badaracco JR, et al. Cardiac troponin T levels are associated with poor short- and long-term prognosis in patients with acute cardiogenic pulmonary edema. Am Heart J 2002;143:814-20.
Grossman W. Defining diastolic dysfunction. Circulation 2000;101:2020-1.
Dauterman KW, Massie BM, Gheorghiade M. Heart failure associated with preserved systolic function: A common and costly clinical entity. Am Heart J 1998;135:S310-9.
Sacchetti A, Ramoska E, Moakes ME, McDermott P, Moyer V. Effect of ED management on ICU use in acute pulmonary edema. Am J Emerg Med 1999;17:571-4.
Mort TC. The incidence and risk factors for cardiac arrest during emergency tracheal intubation: A justification for incorporating the ASA Guidelines in the remote location. J Clin Anesth 2004;16:508-16.
Heffner AC, Swords DS, Neale MN, Jones AE. Incidence and factors associated with cardiac arrest complicating emergency airway management. Resuscitation 2013;84:1500-4.
Lenique F, Habis M, Lofaso F, Dubois-Randé JL, Harf A, Brochard L. Ventilatory and hemodynamic effects of continuous positive airway pressure in left heart failure. Am J Respir Crit Care Med 1997;155:500-5.
Hess DR. The evidence for noninvasive positive-pressure ventilation in the care of patients in acute respiratory failure: A systematic review of the literature. Respir Care 2004;49:810-29.
Agarwal R, Aggarwal AN, Gupta D, Jindal SK. Non-invasive ventilation in acute cardiogenic pulmonary oedema. Postgrad Med J 2005;81:637-43.
Collins SP, Mielniczuk LM, Whittingham HA, Boseley ME, Schramm DR, Storrow AB. The use of noninvasive ventilation in emergency department patients with acute cardiogenic pulmonary edema: A systematic review. Ann Emerg Med 2006;48:260-9.
Crane SD, Elliott MW, Gilligan P, Richards K, Gray AJ. Randomised controlled comparison of continuous positive airways pressure, bilevel non-invasive ventilation, and standard treatment in emergency department patients with acute cardiogenic pulmonary oedema. Emerg Med J 2004;21:155-61.
Kelly CA, Newby DE, McDonagh TA, Mackay TW, Barr J, Boon NA, et al. Randomised controlled trial of continuous positive airway pressure and standard oxygen therapy in acute pulmonary oedema; effects on plasma brain natriuretic peptide concentrations. Eur Heart J 2002;23:1379-86.
Gray A, Goodacre S, Newby DE, Masson M, Sampson F, Nicholl J; CPO Trialists. Noninvasive ventilation in acute cardiogenic pulmonary edema. N Engl J Med 2008;359:142-51.
Kwok H, McCormack J, Cece R, Houtchens J, Hill NS. Controlled trial of oronasal versus nasal mask ventilation in the treatment of acute respiratory failure. Crit Care Med 2003;31:468-73.
Cotter G, Metzkor E, Kaluski E, Faigenberg Z, Miller R, Simovitz A, et al. Randomised trial of high-dose isosorbide dinitrate plus low-dose furosemide versus high-dose furosemide plus low-dose isosorbide dinitrate in severe pulmonary oedema. Lancet 1998;351:389-93.
Levy P, Compton S, Welch R, Delgado G, Jennett A, Penugonda N, et al. Treatment of severe decompensated heart failure with high-dose intravenous nitroglycerin: A feasibility and outcome analysis. Ann Emerg Med 2007;50:144-52.
Sharon A, Shpirer I, Kaluski E, Moshkovitz Y, Milovanov O, Polak R, et al. High-dose intravenous isosorbide-dinitrate is safer and better than Bi-PAP ventilation combined with conventional treatment for severe pulmonary edema. J Am Coll Cardiol 2000;36:832-7.
Nashed AH, Allegra JR. Intravenous nitroglycerin boluses in treating patients with cardiogenic pulmonary edema. Am J Emerg Med 1995;13:612-3.
Vismara LA, Leaman DM, Zelis R. The effects of morphine on venous tone in patients with acute pulmonary edema. Circulation 1976;54:335-7.
Chambers JA, Baggoley CJ. Pulmonary oedema - Prehospital treatment. Caution with morphine dosage. Med J Aust 1992;157:326-8.
Sosnowski MA. Review article: Lack of effect of opiates in the treatment of acute cardiogenic pulmonary oedema. Emerg Med Australas 2008;20:384-90.
Felker GM, O′Connor CM, Braunwald E; Heart Failure Clinical Research Network Investigators. Loop diuretics in acute decompensated heart failure: Necessary? Evil? A necessary evil? Circ Heart Fail 2009;2:56-62.