Ça on le savait Les études démontrent plutôt le contraire Suaf les rares exception où un geste avancé change le outcome La médicalisation gruge le temps de l'équipe chirurgicale Charles http://www.cmaj.ca/content/vol178/issue9/?etoc The OPALS Major Trauma Study: impact of advanced life-support on survival and morbidity Ian G. Stiell, MD MSc, Lisa P. Nesbitt, MHA, William Pickett, PhD, Douglas Munkley, MD, Daniel W. Spaite, MD, Jane Banek, CHIM, Brian Field, MBA EMCA, Lorraine Luinstra-Toohey, BScN MHA, Justin Maloney, MD, Jon Dreyer, MD, Marion Lyver, MD, Tony Campeau, MAEd PhD, George A. Wells, PhD for the OPALS Study Group From the Departments of Emergency Medicine (Stiell) and of Epidemiology and Community Medicine (Wells), University of Ottawa, Ottawa, Ont.; the Clinical Epidemiology Program, Ottawa Health Research Institute (Stiell, Nesbitt, Banek, Wells), Ottawa, Ont.; the Department of Emergency Medicine (Pickett), Queen's University, Kingston, Ont.; Greater Niagara Base Hospital (Munkley, Luinstra-Toohey), Niagara Falls, Ont.; the Department of Emergency Medicine (Spaite), University of Arizona, Tucson, Ariz.; Interdev Technologies (Field), Toronto, Ont.; Ottawa Base Hospital Program (Maloney), Ottawa, Ont.; the Division of Emergency Medicine (Dreyer), University of Western Ontario, London, Ont.; the Department of Family Medicine (Lyver), McMaster University, Hamilton, Ont.; and Emergency Health Services (Campeau), Ontario Ministry of Health and Long-Term Care, Toronto, Ont. Correspondence to: Dr. Ian G. Stiell, Clinical Epidemiology Unit, Rm. F657, Ottawa Health Research Institute, The Ottawa Hospital Civic Campus, 1053 Carling Ave., Ottawa ON K1Y 4E9; fax 613 761-5351; [EMAIL PROTECTED] Background: To date, the benefit of prehospital advanced life-supportprograms on trauma-related mortality and morbidity has not beenestablished Methods: The Ontario Prehospital Advanced Life Support (OPALS)Major Trauma Study was a beforeafter systemwide controlledclinical trial conducted in 17 cities. We enrolled adult patientswho had experienced major trauma in a basic life-support phaseand a subsequent advanced life-support phase (during which paramedicswere able to perform endotracheal intubation and administerfluids and drugs intravenously). The primary outcome was survivalto hospital discharge. Results: Among the 2867 patients enrolled in the basic life-support(n = 1373) and advanced life-support (n = 1494) phases, characteristicswere similar, including mean age (44.8 v. 47.5 years), frequencyof blunt injury (92.0% v. 91.4%), median injury severity score(24 v. 22) and percentage of patients with Glasgow Coma Scalescore less than 9 (27.2% v. 22.1%). Survival did not differoverall (81.1% among patients in the advanced life-support phasev. 81.8% among those in the basic life-support phase; p = 0.65).Among patients with Glasgow Coma Scale score less than 9, survivalwas lower among those in the advanced life-support phase (50.9%v. 60.0%; p = 0.02). The adjusted odds of death for the advancedlife-support v. basic life-support phases were nonsignificant(1.2, 95% confidence interval 0.91.7; p = 0.16). Interpretation: The OPALS Major Trauma Study showed that systemwideimplementation of full advanced life-support programs did notdecrease mortality or morbidity for major trauma patients. Wealso found that during the advanced life-support phase, mortalitywas greater among patients with Glasgow Coma Scale scores lessthan 9. We believe that emergency medical services should carefullyre-evaluate the indications for and application of prehospitaladvanced life-support measures for patients who have experiencedmajor trauma.
