Advanced life support for out-of-hospital respiratory distress

Ian G. Stiell, Daniel W Spaite, Brian Field, Lisa P. Nesbitt, Doug Munkley, Justin Maloney, Jon Dreyer, Lorraine Luinstra Toohey, Tony Campeau, Eugene Dagnone, Marion Lyver, George A. Wells

Research output: Contribution to journalArticle

73 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)2156-2164
Number of pages9
JournalNew England Journal of Medicine
Volume356
Issue number21
DOIs
StatePublished - May 24 2007

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Allied Health Personnel
Intratracheal Intubation
Emergency Medical Services
Confidence Intervals
Mortality
Albuterol
Controlled Clinical Trials
Nitroglycerin
Ontario
Pharmaceutical Preparations
Intravenous Administration
Hospital Emergency Service
Odds Ratio
Therapeutics

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Stiell, I. G., Spaite, D. W., Field, B., Nesbitt, L. P., Munkley, D., Maloney, J., ... Wells, G. A. (2007). Advanced life support for out-of-hospital respiratory distress. New England Journal of Medicine, 356(21), 2156-2164. https://doi.org/10.1056/NEJMoa060334

Advanced life support for out-of-hospital respiratory distress. / Stiell, Ian G.; Spaite, Daniel W; Field, Brian; Nesbitt, Lisa P.; Munkley, Doug; Maloney, Justin; Dreyer, Jon; Toohey, Lorraine Luinstra; Campeau, Tony; Dagnone, Eugene; Lyver, Marion; Wells, George A.

In: New England Journal of Medicine, Vol. 356, No. 21, 24.05.2007, p. 2156-2164.

Research output: Contribution to journalArticle

Stiell, IG, Spaite, DW, Field, B, Nesbitt, LP, Munkley, D, Maloney, J, Dreyer, J, Toohey, LL, Campeau, T, Dagnone, E, Lyver, M & Wells, GA 2007, 'Advanced life support for out-of-hospital respiratory distress', New England Journal of Medicine, vol. 356, no. 21, pp. 2156-2164. https://doi.org/10.1056/NEJMoa060334
Stiell IG, Spaite DW, Field B, Nesbitt LP, Munkley D, Maloney J et al. Advanced life support for out-of-hospital respiratory distress. New England Journal of Medicine. 2007 May 24;356(21):2156-2164. https://doi.org/10.1056/NEJMoa060334
Stiell, Ian G. ; Spaite, Daniel W ; Field, Brian ; Nesbitt, Lisa P. ; Munkley, Doug ; Maloney, Justin ; Dreyer, Jon ; Toohey, Lorraine Luinstra ; Campeau, Tony ; Dagnone, Eugene ; Lyver, Marion ; Wells, George A. / Advanced life support for out-of-hospital respiratory distress. In: New England Journal of Medicine. 2007 ; Vol. 356, No. 21. pp. 2156-2164.
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AU - Spaite, Daniel W

AU - Field, Brian

AU - Nesbitt, Lisa P.

AU - Munkley, Doug

AU - Maloney, Justin

AU - Dreyer, Jon

AU - Toohey, Lorraine Luinstra

AU - Campeau, Tony

AU - Dagnone, Eugene

AU - Lyver, Marion

AU - Wells, George A.

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N2 - 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.

AB - 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.

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