FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 356:2156-2164 May 24, 2007 Number 21 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set CME Exam Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Respiratory distress is a common symptom of patients transported to hospitals by emergency medical services (EMS) personnel. The benefit of advanced life support for such patients has not been established.

Methods The Ontario Prehospital Advanced Life Support (OPALS) Study was a controlled clinical trial that was conducted in 15 cities before and after the implementation of a program to provide advanced life support for patients with out-of-hospital respiratory distress. Paramedics were trained in standard advanced life support, including endotracheal intubation and the administration of intravenous drugs.

Results The clinical characteristics of the 8138 patients in the two phases of the study were similar. During the first phase, no patients were treated by paramedics trained in advanced life support; during the second phase, 56.6% of patients received this treatment. Endotracheal intubation was performed in 1.4% of the patients, and intravenous drugs were administered to 15.0% during the second phase. This phase of the study was also marked by a substantial increase in the use of nebulized salbutamol and sublingual nitroglycerin for the relief of symptoms. The rate of death among all patients decreased significantly, from 14.3% to 12.4% (absolute difference, 1.9%; 95% confidence interval [CI], 0.4 to 3.4; P=0.01) from the basic-life-support phase to the advanced-life-support phase (adjusted odds ratio, 1.3; 95% CI, 1.1 to 1.5).

Conclusions The addition of a specific regimen of out-of-hospital advanced-life-support interventions to an existing EMS system that provides basic life support was associated with a decrease in the rate of death of 1.9 percentage points among patients with respiratory distress.

Source Information

From the Department of Emergency Medicine (I.G.S., J.M.), Department of Epidemiology and Community Medicine (G.A.W.), Clinical Epidemiology Program (L.P.N.), Ottawa Health Research Institute, University of Ottawa, Ottawa; the Department of Emergency Medicine, University of Arizona, Tucson (D.W.S.); the Department of Emergency Medicine, Queens University, Kingston, ON, Canada (E.D.); Emergency Health Services, Ontario Ministry of Health and Long-Term Care, Toronto (T.C.); Niagara Regional Base Hospital, Niagara Falls, ON, Canada (D.M., L.L.T.); the Division of Emergency Medicine, University of Western Ontario, London, ON, Canada (J.D.); Joseph Brant Memorial Hospital, Burlington, ON, Canada (M.L.); and Interdev Technologies, Toronto (B.F.).

Full Text of this Article

This article has been cited by other articles:

• Stiell, I. G. MD MSc, Nesbitt, L. P. MHA, Pickett, W. PhD, Munkley, D. MD, Spaite, D. W. MD, Banek, J. CHIM, Field, B. MBA EMCA, Luinstra-Toohey, L. BScN MHA, Maloney, J. MD, Dreyer, J. MD, Lyver, M. MD, Campeau, T. MAEd PhD, Wells, G. A. PhD, for the OPALS Study Group, (2008). The OPALS Major Trauma Study: impact of advanced life-support on survival and morbidity. CMAJ 178: 1141-1152 [Abstract] [Full Text]  
• Davis, D. P. MD (2008). Should invasive airway management be done in the field?. CMAJ 178: 1171-1173 [Full Text]  
• (2007). ALS May (or May Not) Improve Survival in Respiratory Distress. JWatch Emergency Med. 2007: 1-1 [Full Text]