OPALS 重大创伤研究：高级生命支持对生存和发病率的影响。
The OPALS Major Trauma Study: impact of advanced life-support on survival and morbidity.
作者信息
Stiell Ian G, Nesbitt Lisa P, Pickett William, Munkley Douglas, Spaite Daniel W, Banek Jane, Field Brian, Luinstra-Toohey Lorraine, Maloney Justin, Dreyer Jon, Lyver Marion, Campeau Tony, Wells George A
机构信息
The Department of Emergency Medicine, University of Ottawa, and the Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Ont.
出版信息
CMAJ. 2008 Apr 22;178(9):1141-52. doi: 10.1503/cmaj.071154.
BACKGROUND
To date, the benefit of prehospital advanced life-support programs on trauma-related mortality and morbidity has not been established
METHODS
The Ontario Prehospital Advanced Life Support (OPALS) Major Trauma Study was a before-after systemwide controlled clinical trial conducted in 17 cities. We enrolled adult patients who had experienced major trauma in a basic life-support phase and a subsequent advanced life-support phase (during which paramedics were able to perform endotracheal intubation and administer fluids and drugs intravenously). The primary outcome was survival to hospital discharge.
RESULTS
Among the 2867 patients enrolled in the basic life-support (n = 1373) and advanced life-support (n = 1494) phases, characteristics were similar, including mean age (44.8 v. 47.5 years), frequency of blunt injury (92.0% v. 91.4%), median injury severity score (24 v. 22) and percentage of patients with Glasgow Coma Scale score less than 9 (27.2% v. 22.1%). Survival did not differ overall (81.1% among patients in the advanced life-support phase v. 81.8% among those in the basic life-support phase; p = 0.65). Among patients with Glasgow Coma Scale score less than 9, survival was lower among those in the advanced life-support phase (50.9% v. 60.0%; p = 0.02). The adjusted odds of death for the advanced life-support v. basic life-support phases were nonsignificant (1.2, 95% confidence interval 0.9-1.7; p = 0.16).
INTERPRETATION
The OPALS Major Trauma Study showed that systemwide implementation of full advanced life-support programs did not decrease mortality or morbidity for major trauma patients. We also found that during the advanced life-support phase, mortality was greater among patients with Glasgow Coma Scale scores less than 9. We believe that emergency medical services should carefully re-evaluate the indications for and application of prehospital advanced life-support measures for patients who have experienced major trauma.
背景
迄今为止，院前高级生命支持项目对创伤相关死亡率和发病率的益处尚未得到证实。
方法
安大略省院前高级生命支持（OPALS）重大创伤研究是一项在17个城市进行的全系统前后对照临床试验。我们纳入了在基础生命支持阶段和随后的高级生命支持阶段（在此期间护理人员能够进行气管插管并静脉输注液体和药物）经历重大创伤的成年患者。主要结局是存活至出院。
结果
在纳入基础生命支持阶段（n = 1373）和高级生命支持阶段（n = 1494）的2867例患者中，特征相似，包括平均年龄（44.8岁对47.5岁）、钝性损伤频率（92.0%对91.4%）、中位损伤严重程度评分（24对22）以及格拉斯哥昏迷量表评分低于9分的患者百分比（27.2%对22.1%）。总体生存率无差异（高级生命支持阶段患者为81.1%，基础生命支持阶段患者为81.8%；p = 0.65）。在格拉斯哥昏迷量表评分低于9分的患者中，高级生命支持阶段患者的生存率较低（50.9%对60.0%；p = 0.02）。高级生命支持阶段与基础生命支持阶段相比，调整后的死亡 odds 无统计学意义（1.2，95%置信区间 0.9 - 1.7；p = 0.16）。
解读
OPALS重大创伤研究表明，全系统实施全面的高级生命支持项目并未降低重大创伤患者的死亡率或发病率。我们还发现，在高级生命支持阶段，格拉斯哥昏迷量表评分低于9分的患者死亡率更高。我们认为，紧急医疗服务机构应仔细重新评估对经历重大创伤患者进行院前高级生命支持措施的指征和应用。
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