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Previous Volume 351:647-656 August 12, 2004 Number 7 Next

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ABSTRACT

Background The Ontario Prehospital Advanced Life Support (OPALS) Study tested the incremental effect on the rate of survival after out-of-hospital cardiac arrest of adding a program of advanced life support to a program of rapid defibrillation.

Methods This multicenter, controlled clinical trial was conducted in 17 cities before and after advanced-life-support programs were instituted and enrolled 5638 patients who had had cardiac arrest outside the hospital. Of those patients, 1391 were enrolled during the rapid-defibrillation phase and 4247 during the subsequent advanced-life-support phase. Paramedics were trained in standard advanced life support, which includes endotracheal intubation and the administration of intravenous drugs.

Results From the rapid-defibrillation phase to the advanced-life-support phase, the rate of admission to a hospital increased significantly (10.9 percent vs. 14.6 percent, P<0.001), but the rate of survival to hospital discharge did not (5.0 percent vs. 5.1 percent, P=0.83). The multivariate odds ratio for survival after advanced life support was 1.1 (95 percent confidence interval, 0.8 to 1.5); after an arrest witnessed by a bystander, 4.4 (95 percent confidence interval, 3.1 to 6.4); after cardiopulmonary resuscitation administered by a bystander, 3.7 (95 percent confidence interval, 2.5 to 5.4); and after rapid defibrillation, 3.4 (95 percent confidence interval, 1.4 to 8.4). There was no improvement in the rate of survival with the use of advanced life support in any subgroup.

Conclusions The addition of advanced-life-support interventions did not improve the rate of survival after out-of-hospital cardiac arrest in a previously optimized emergency-medical-services system of rapid defibrillation. In order to save lives, health care planners should make cardiopulmonary resuscitation by citizens and rapid-defibrillation responses a priority for the resources of emergency-medical-services systems.

Source Information

From the Departments of Emergency Medicine (I.G.S.), Epidemiology and Community Medicine (G.A.W.), and Medicine (G.N.), and the Clinical Epidemiology Program (L.P.N., D.C., J.B.), Ottawa Health Research Institute, University of Ottawa, Ottawa Ont., Canada; Interdev Technologies, Toronto (B.F.); the Department of Emergency Medicine, University of Arizona, Tucson (D.W.S.); the Department of Emergency Medicine, University of North Carolina, Chapel Hill (V.J.D.); the Greater Niagara Base Hospital, Niagara Falls, Ont., Canada (D.M., L.L.-T.); Emergency Health Services, Ontario Ministry of Health and Long-Term Care, Toronto (T.C.); the Department of Emergency Medicine, Queens University, Kingston, Ont., Canada (E.D.); and the Department of Family Medicine, McMaster University, Hamilton, Ont., Canada (M.L.).

Address reprint requests to Dr. Stiell at the Clinical Epidemiology Unit, Office F657, Ottawa Health Research Institute, the Ottawa Hospital, Civic Campus, 1053 Carling Ave., Ottawa, ON K1Y 4E9, Canada, or at istiell{at}ohri.ca.

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Advanced Cardiac Life Support
Nurok M., Stiell I. G., the OPALS Study Group , Callans D. J.
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N Engl J Med 2004; 351:2553-2554, Dec 9, 2004. Correspondence

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