Advanced life support for out-of-hospital respiratory distress.
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.
Stiell
Ian G
IG
Department of Emergency Medicine, Ottawa Health Research Institute, University of Ottawa, Ottawa, ON, Canada.
Spaite
Daniel W
DW
Field
Brian
B
Nesbitt
Lisa P
LP
Munkley
Doug
D
Maloney
Justin
J
Dreyer
Jon
J
Toohey
Lorraine Luinstra
LL
Campeau
Tony
T
Dagnone
Eugene
E
Lyver
Marion
M
Wells
George A
GA
D000293:Adolescent; D000328:Adult; D022561:Advanced Cardiac Life Support / Q000193:education; D000368:Aged; D000369:Aged, 80 and over; D004358:Drug Therapy; D004417:Dyspnea / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D004632:Emergency Medical Services; D004634:Emergency Medical Technicians / Q000193:education; D005260:Female; D006333:Heart Failure / Q000150:complications; D006801:Humans; D007442:Intubation, Intratracheal; D008171:Lung Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome