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
Department of Emergency Medicine, Ottawa Health Research Institute, University of Ottawa, Ottawa, ON, Canada.
N Engl J Med. 2007 May 24;356(21):2156-64. doi: 10.1056/NEJMoa060334.
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.
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.
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).
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.
呼吸窘迫是由紧急医疗服务（EMS）人员送往医院的患者的常见症状。对于此类患者，高级生命支持的益处尚未确定。
安大略省院前高级生命支持（OPALS）研究是一项对照临床试验，在为院外呼吸窘迫患者提供高级生命支持的项目实施前后，于15个城市开展。护理人员接受了标准的高级生命支持培训，包括气管插管和静脉用药。
研究两个阶段的8138例患者的临床特征相似。在第一阶段，没有患者接受过高级生命支持培训的护理人员的治疗；在第二阶段，56.6%的患者接受了这种治疗。在第二阶段，1.4%的患者进行了气管插管，15.0%的患者使用了静脉药物。该阶段研究还以雾化沙丁胺醇和舌下硝酸甘油用于缓解症状的使用大幅增加为特征。从基础生命支持阶段到高级生命支持阶段，所有患者的死亡率显著下降，从14.3%降至12.4%（绝对差异为1.9%；95%置信区间[CI]为0.4至3.4；P=0.01）（调整后的优势比为1.3；95%CI为1.1至1.5）。
在提供基础生命支持的现有EMS系统中增加院外高级生命支持干预的特定方案，与呼吸窘迫患者死亡率降低1.9个百分点相关。
