Advanced cardiac life support in out-of-hospital cardiac arrest

Ian G. Stiell, George A. Wells, Brian Field, Daniel W Spaite, Lisa P. Nesbitt, Valerie J. De Maio, Graham Nichol, Donna Cousineau, Josée Blackburn, Doug Munkley, Lorraine Luinstra-Toohey, Tony Campeau, Eugene Dagnone, Marion Lyver

Research output: Contribution to journalArticle

624 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)647-656
Number of pages10
JournalNew England Journal of Medicine
Volume351
Issue number7
DOIs
StatePublished - Aug 12 2004

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Advanced Cardiac Life Support
Out-of-Hospital Cardiac Arrest
Survival Rate
Confidence Intervals
Cardiopulmonary Resuscitation
Emergency Medical Services
Allied Health Personnel
Intratracheal Intubation
Controlled Clinical Trials
Ontario
Heart Arrest
Intravenous Administration
Odds Ratio

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Stiell, I. G., Wells, G. A., Field, B., Spaite, D. W., Nesbitt, L. P., De Maio, V. J., ... Lyver, M. (2004). Advanced cardiac life support in out-of-hospital cardiac arrest. New England Journal of Medicine, 351(7), 647-656. https://doi.org/10.1056/NEJMoa040325

Advanced cardiac life support in out-of-hospital cardiac arrest. / Stiell, Ian G.; Wells, George A.; Field, Brian; Spaite, Daniel W; Nesbitt, Lisa P.; De Maio, Valerie J.; Nichol, Graham; Cousineau, Donna; Blackburn, Josée; Munkley, Doug; Luinstra-Toohey, Lorraine; Campeau, Tony; Dagnone, Eugene; Lyver, Marion.

In: New England Journal of Medicine, Vol. 351, No. 7, 12.08.2004, p. 647-656.

Research output: Contribution to journalArticle

Stiell, IG, Wells, GA, Field, B, Spaite, DW, Nesbitt, LP, De Maio, VJ, Nichol, G, Cousineau, D, Blackburn, J, Munkley, D, Luinstra-Toohey, L, Campeau, T, Dagnone, E & Lyver, M 2004, 'Advanced cardiac life support in out-of-hospital cardiac arrest', New England Journal of Medicine, vol. 351, no. 7, pp. 647-656. https://doi.org/10.1056/NEJMoa040325
Stiell, Ian G. ; Wells, George A. ; Field, Brian ; Spaite, Daniel W ; Nesbitt, Lisa P. ; De Maio, Valerie J. ; Nichol, Graham ; Cousineau, Donna ; Blackburn, Josée ; Munkley, Doug ; Luinstra-Toohey, Lorraine ; Campeau, Tony ; Dagnone, Eugene ; Lyver, Marion. / Advanced cardiac life support in out-of-hospital cardiac arrest. In: New England Journal of Medicine. 2004 ; Vol. 351, No. 7. pp. 647-656.
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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.",
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AU - Field, Brian

AU - Spaite, Daniel W

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AU - De Maio, Valerie J.

AU - Nichol, Graham

AU - Cousineau, Donna

AU - Blackburn, Josée

AU - Munkley, Doug

AU - Luinstra-Toohey, Lorraine

AU - Campeau, Tony

AU - Dagnone, Eugene

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N2 - 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.

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