Advanced cardiac life support.

Abstract

Although Stiell and colleagues (Aug. 12 issue)¹ state that the Ontario Prehospital Advanced Life Support (OPALS) Study found no improvement in the rate of survival among patients with out-of-hospital cardiac arrest as a result of the addition of “advanced life support” interventions provided by paramedics (and Callans concurred in the accompanying Perspective article),² these findings cannot be generalized to all emergency-medical-services systems. The authors suggest that definitive care is “advanced life support.” I would submit that definitive care must be viewed as definitive therapy for a patient's underlying conditions. Myocardial infarction is a common cause of cardiac arrest. Definitive therapy includes thrombolysis and cardiac catheterization. In this regard, “advanced life support,” as described in the present study, is supportive therapy, not definitive. The findings of this study should therefore be generalized only to emergency-medical-services systems in which paramedics provide advanced life support until the patient's admission to an emergency department, where the decisions are made regarding sending patients further to sites of definitive care. The findings cannot be generalized to systems in which physicians provide prehospital care that includes thrombolysis with direct admission to a coronary care unit or direct admission to cardiac catheterization facilities (in both cases, bypassing the emergency department), as occurs in many parts of Europe.