Advanced cardiac life support in out-of-hospital cardiac arrest.
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.
Stiell
Ian G
IG
Department of Emergency Medicine, Ottawa Health Research Institute, University of Ottawa, Ottawa Ont, Canada. istiell@ohri.ca
Wells
George A
GA
Field
Brian
B
Spaite
Daniel W
DW
Nesbitt
Lisa P
LP
De Maio
Valerie J
VJ
Nichol
Graham
G
Cousineau
Donna
D
Blackburn
Josée
J
Munkley
Doug
D
Luinstra-Toohey
Lorraine
L
Campeau
Tony
T
Dagnone
Eugene
E
Lyver
Marion
M
D000293:Adolescent; D000328:Adult; D022561:Advanced Cardiac Life Support; D000368:Aged; D004554:Electric Countershock; D004632:Emergency Medical Services; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D009864:Ontario; D017063:Outcome Assessment, Health Care; D015996:Survival Rate; D019037:Urban Health Services