Modifiable factors associated with improved cardiac arrest survival in a multicenter basic life support/defibrillation system

OPALS study phase I results

I. G. Stiell, G. A. Wells, V. J. DeMaio, Daniel W Spaite, B. J. Field, D. P. Munkley, M. B. Lyver, L. G. Luinstra, R. Ward

Research output: Contribution to journalArticle

241 Citations (Scopus)

Abstract

Study objectives: This study was conducted to identify modifiable factors associated with survival for prehospital cardiac arrest in a large, multicenter EMS system with basic life support/defibrillation (BLS-D) level of care. Methods: This observational cohort study constitutes Phase I of the 3-phase Ontario Prehospital Advanced Life Support (OPALS) Study. Included were all adults who had cardiac arrest before EMS arrival in 21 urban/suburban communities that operate under the jurisdiction of 1 ambulance services branch, have 911 telephone service, and provide ambulance defibrillation but no prehospital advanced life support (ALS). Central dispatch and ambulance records were reviewed according to the Utstein guidelines. Associations between multiple patient and EMS factors and survival to discharge were assessed by univariate then stepwise logistic regression analyses. Results: From January 1, 1991, to January 31, 1995, 5,335 eligible patients were treated. Of these, 46.8% of cardiac arrests were witnessed by citizens, 14.5% received bystander CPR, 25.6% received CPR by fire or police, and 38.2% had an initial rhythm of ventricular fibrillation/ventricular tachycardia (VF/VT). The mean interval from call received to vehicle stopped was 6.7 minutes. Survival was 3.5% overall and 8.8% for VF/VT. Multivariate analysis found the following factors to be independently associated with survival (odds ratio with 95% confidence intervals): age .81 (.73, .89), bystander-witnessed arrest 4.05 (2.73, 5.90), bystander CPR 2.98 (2.07, 4.29), CPR by fire or police 2.20 (1.46, 3.31), and response interval call received to vehicle stopped .76 (.71, .82). Conclusion: This represents the largest multicenter BLS-D study of prehospital cardiac arrest yet conducted and cleverly indicates that patient survival may be improved by optimization of EMS response intervals, bystander CPR, as well as first-responder CPR by fire or police.

Original languageEnglish (US)
Pages (from-to)44-50
Number of pages7
JournalAnnals of Emergency Medicine
Volume33
Issue number1
DOIs
StatePublished - 1999
Externally publishedYes

Fingerprint

Life Support Systems
Cardiopulmonary Resuscitation
Ontario
Heart Arrest
Ambulances
Survival
Police
Ventricular Fibrillation
Ventricular Tachycardia
Telephone
Observational Studies
Cohort Studies
Multivariate Analysis
Logistic Models
Odds Ratio
Regression Analysis
Guidelines
Confidence Intervals

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Modifiable factors associated with improved cardiac arrest survival in a multicenter basic life support/defibrillation system : OPALS study phase I results. / Stiell, I. G.; Wells, G. A.; DeMaio, V. J.; Spaite, Daniel W; Field, B. J.; Munkley, D. P.; Lyver, M. B.; Luinstra, L. G.; Ward, R.

In: Annals of Emergency Medicine, Vol. 33, No. 1, 1999, p. 44-50.

Research output: Contribution to journalArticle

Stiell, I. G. ; Wells, G. A. ; DeMaio, V. J. ; Spaite, Daniel W ; Field, B. J. ; Munkley, D. P. ; Lyver, M. B. ; Luinstra, L. G. ; Ward, R. / Modifiable factors associated with improved cardiac arrest survival in a multicenter basic life support/defibrillation system : OPALS study phase I results. In: Annals of Emergency Medicine. 1999 ; Vol. 33, No. 1. pp. 44-50.
@article{889d663ea09249589316f45df0880932,
title = "Modifiable factors associated with improved cardiac arrest survival in a multicenter basic life support/defibrillation system: OPALS study phase I results",
abstract = "Study objectives: This study was conducted to identify modifiable factors associated with survival for prehospital cardiac arrest in a large, multicenter EMS system with basic life support/defibrillation (BLS-D) level of care. Methods: This observational cohort study constitutes Phase I of the 3-phase Ontario Prehospital Advanced Life Support (OPALS) Study. Included were all adults who had cardiac arrest before EMS arrival in 21 urban/suburban communities that operate under the jurisdiction of 1 ambulance services branch, have 911 telephone service, and provide ambulance defibrillation but no prehospital advanced life support (ALS). Central dispatch and ambulance records were reviewed according to the Utstein guidelines. Associations between multiple patient and EMS factors and survival to discharge were assessed by univariate then stepwise logistic regression analyses. Results: From January 1, 1991, to January 31, 1995, 5,335 eligible patients were treated. Of these, 46.8{\%} of cardiac arrests were witnessed by citizens, 14.5{\%} received bystander CPR, 25.6{\%} received CPR by fire or police, and 38.2{\%} had an initial rhythm of ventricular fibrillation/ventricular tachycardia (VF/VT). The mean interval from call received to vehicle stopped was 6.7 minutes. Survival was 3.5{\%} overall and 8.8{\%} for VF/VT. Multivariate analysis found the following factors to be independently associated with survival (odds ratio with 95{\%} confidence intervals): age .81 (.73, .89), bystander-witnessed arrest 4.05 (2.73, 5.90), bystander CPR 2.98 (2.07, 4.29), CPR by fire or police 2.20 (1.46, 3.31), and response interval call received to vehicle stopped .76 (.71, .82). Conclusion: This represents the largest multicenter BLS-D study of prehospital cardiac arrest yet conducted and cleverly indicates that patient survival may be improved by optimization of EMS response intervals, bystander CPR, as well as first-responder CPR by fire or police.",
author = "Stiell, {I. G.} and Wells, {G. A.} and DeMaio, {V. J.} and Spaite, {Daniel W} and Field, {B. J.} and Munkley, {D. P.} and Lyver, {M. B.} and Luinstra, {L. G.} and R. Ward",
year = "1999",
doi = "10.1016/S0196-0644(99)70415-4",
language = "English (US)",
volume = "33",
pages = "44--50",
journal = "Annals of Emergency Medicine",
issn = "0196-0644",
publisher = "Mosby Inc.",
number = "1",

}

TY - JOUR

T1 - Modifiable factors associated with improved cardiac arrest survival in a multicenter basic life support/defibrillation system

T2 - OPALS study phase I results

AU - Stiell, I. G.

AU - Wells, G. A.

AU - DeMaio, V. J.

AU - Spaite, Daniel W

AU - Field, B. J.

AU - Munkley, D. P.

AU - Lyver, M. B.

AU - Luinstra, L. G.

AU - Ward, R.

PY - 1999

Y1 - 1999

N2 - Study objectives: This study was conducted to identify modifiable factors associated with survival for prehospital cardiac arrest in a large, multicenter EMS system with basic life support/defibrillation (BLS-D) level of care. Methods: This observational cohort study constitutes Phase I of the 3-phase Ontario Prehospital Advanced Life Support (OPALS) Study. Included were all adults who had cardiac arrest before EMS arrival in 21 urban/suburban communities that operate under the jurisdiction of 1 ambulance services branch, have 911 telephone service, and provide ambulance defibrillation but no prehospital advanced life support (ALS). Central dispatch and ambulance records were reviewed according to the Utstein guidelines. Associations between multiple patient and EMS factors and survival to discharge were assessed by univariate then stepwise logistic regression analyses. Results: From January 1, 1991, to January 31, 1995, 5,335 eligible patients were treated. Of these, 46.8% of cardiac arrests were witnessed by citizens, 14.5% received bystander CPR, 25.6% received CPR by fire or police, and 38.2% had an initial rhythm of ventricular fibrillation/ventricular tachycardia (VF/VT). The mean interval from call received to vehicle stopped was 6.7 minutes. Survival was 3.5% overall and 8.8% for VF/VT. Multivariate analysis found the following factors to be independently associated with survival (odds ratio with 95% confidence intervals): age .81 (.73, .89), bystander-witnessed arrest 4.05 (2.73, 5.90), bystander CPR 2.98 (2.07, 4.29), CPR by fire or police 2.20 (1.46, 3.31), and response interval call received to vehicle stopped .76 (.71, .82). Conclusion: This represents the largest multicenter BLS-D study of prehospital cardiac arrest yet conducted and cleverly indicates that patient survival may be improved by optimization of EMS response intervals, bystander CPR, as well as first-responder CPR by fire or police.

AB - Study objectives: This study was conducted to identify modifiable factors associated with survival for prehospital cardiac arrest in a large, multicenter EMS system with basic life support/defibrillation (BLS-D) level of care. Methods: This observational cohort study constitutes Phase I of the 3-phase Ontario Prehospital Advanced Life Support (OPALS) Study. Included were all adults who had cardiac arrest before EMS arrival in 21 urban/suburban communities that operate under the jurisdiction of 1 ambulance services branch, have 911 telephone service, and provide ambulance defibrillation but no prehospital advanced life support (ALS). Central dispatch and ambulance records were reviewed according to the Utstein guidelines. Associations between multiple patient and EMS factors and survival to discharge were assessed by univariate then stepwise logistic regression analyses. Results: From January 1, 1991, to January 31, 1995, 5,335 eligible patients were treated. Of these, 46.8% of cardiac arrests were witnessed by citizens, 14.5% received bystander CPR, 25.6% received CPR by fire or police, and 38.2% had an initial rhythm of ventricular fibrillation/ventricular tachycardia (VF/VT). The mean interval from call received to vehicle stopped was 6.7 minutes. Survival was 3.5% overall and 8.8% for VF/VT. Multivariate analysis found the following factors to be independently associated with survival (odds ratio with 95% confidence intervals): age .81 (.73, .89), bystander-witnessed arrest 4.05 (2.73, 5.90), bystander CPR 2.98 (2.07, 4.29), CPR by fire or police 2.20 (1.46, 3.31), and response interval call received to vehicle stopped .76 (.71, .82). Conclusion: This represents the largest multicenter BLS-D study of prehospital cardiac arrest yet conducted and cleverly indicates that patient survival may be improved by optimization of EMS response intervals, bystander CPR, as well as first-responder CPR by fire or police.

UR - http://www.scopus.com/inward/record.url?scp=0032906924&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0032906924&partnerID=8YFLogxK

U2 - 10.1016/S0196-0644(99)70415-4

DO - 10.1016/S0196-0644(99)70415-4

M3 - Article

VL - 33

SP - 44

EP - 50

JO - Annals of Emergency Medicine

JF - Annals of Emergency Medicine

SN - 0196-0644

IS - 1

ER -