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Acute cardiogenic pulmonary oedema (ACPO) is a relatively frequent cause for emergency presentation with difficulty in breathing. Failure of the heart muscle to pump properly causes fluid to build up on the patient's lungs causing shortness of breath. Current standard therapy for this condition involves treatment with oxygen and drugs to help the heart pump more effectively. Despite this treatment, patients with this condition may deteriorate and require treatment on an intensive care unit, may develop a heart attack, or may die.

Continuous positive airway pressure (CPAP) and non invasive ventilation (NIV) are two techniques used to help breathing that may be useful for patients with ACPO. Oxygen-enriched air is supplied to the patient's lungs via a tight fitting mouthpiece. This is either supplied under constant pressure (CPAP) or varying pressure (NIV).

These approaches have theoretical advantages and disadvantages. Small trials have shown that CPAP and NIV seem to be safe and may reduce the patient's chances of having to receive intensive care. We now need to find out whether CPAP and/or NIV changes outcomes that are really important to the patient, such as their chances of surviving or having a heart attack.

The 3CPO Trial is a large scientific study taking place in fifteen hospitals across the United Kingdom. Patients attending these hospitals with ACPO will be asked to take part in the trial (or if they are too unwell, their relatives will be asked). If they agree, they will be randomly allocated to receive CPAP, NIV or standard treatment. All patients will be followed up to find out whether they recover from ACPO, whether they have a heart attack or require intensive care, and what their quality of life is like at one month, thee months and six months after their initial attendance at hospital.

It is planned that 1200 patients will be enrolled in the trial. This will allow us to determine whether CPAP or NIV can improve treatment for ACPO. If this trial shows that treatment can be improved by one or other of these techniques then we can recommend that this should become standard treatment throughout the National Health Service.