The following table
is a listing of major randomized or pseudo-randomized
clinical trials completed in the prehospital
setting.
Modified with permission from the BMJ Publishing
Group from a table by Brazier H, Murphy AW, Lynch C, Bury G. Searching
for the evidence in pre-hospital care: a review of randomised controlled
trials. On behalf of the Ambulance Response Time Sub-Group of the National
Ambulance Advisory Committee. J Accid Emerg Med 1999; 16(1):18-23.
The original table is available on the Internet at www.rcsi.ie/library/prehospital_care.html.
|
Trial
|
Patients
|
Setting
|
N
|
Intervention
|
Main
Result
|
|
Valentine et al. 197440
|
Adults younger than 70 with high
suspicion for AMI
|
Multicenter, Australia
|
269
|
Physician intramuscular injection
of (a) lidocaine or (b) placebo
|
During first two hours after injection,
5% absolute reduction in mortality
(p<0.04)
|
|
Hampton and Nicholas 197841
|
Adult patients without motor-vehicle
trauma
|
Nottingham, England
|
3,340
|
(a) Transport by mobile coronary
care unit or (b) routine transport
|
2% absolute reduction in mortality
from heart attacks (NS)
|
|
Diederich et al. 197942
|
Acute myocardial infarction patients
younger than 70
|
Lubeck, Germany
|
|
Intramuscular injection of (a)
lidocaine or (b) placebo
|
Mortality lower in lidocaine group.
|
|
Mahoney and Mirick 1983105
|
Cardiac arrest patients older than
20
|
Minneapolis, Minnesota
|
136
|
(a) Pneumatic antishock garments
or (b) usual care
|
Survival to hospital discharge
was 9% in (a) and 4% in (b) (NS).
|
|
Mateer et al. 1984106
|
Cardiac arrest patients
|
Milwaukee, Wisconsin
|
140
|
After endotracheal intubation either
(a) interposed abdominal compression
CPR (IAC-CPR) or (b) standard CPR
|
4% absolute increase in patients
admitted to ED with a pulse (NS)
|
|
Olson et al. 1984107
|
Ventricular fibrillation persisting
after initial shocks
|
Milwaukee, Wisconsin
|
92
|
(a) Bretylium and then, if VF persists,
lidocaine or (b) lidocaine and then,
if VF persists, bretylium
|
Survival to hospital discharge
was 5% in bretylium first group
vs 10% in lidocaine first group
(NS)
|
|
Paris et al. 1984108
|
Cardiac arrest patients with pulseless
idioventricular rhythm
|
Pittsburgh, Pennsylvania
|
86
|
(a) Dexamethasone 100 mg or (b)
saline placebo
|
No long term survivors in either
group
|
|
Stueven et al. 1984109
|
Witnessed non-traumatic adult cardiac
arrest patients with asystole and
not responding to epinephrine, bicarbonate,
or atropine
|
Milwaukee, Wisconsin
|
32
|
(a) Calcium chloride or (b) saline
placebo
|
No long term survivors in either
group
|
|
Bickell et al. 1985110
|
Injured patients with hypotension
|
Houston, Texas
|
68
|
(a) Pneumatic antishock garments
or (b) usual care
|
No difference in presenting emergency
department trauma score
|
|
Mateer et al. 1985111
|
Same as Mateer et al. 1984106
|
Milwaukee, Wisconsin
|
291
|
After endotracheal intubation either
(a) interposed abdominal compression
CPR (IAC-CPR) or (b) standard CPR
|
3% absolute decrease in patients
admitted to ED with a pulse (NS)
|
|
Silfvast et al. 1985112
|
Patients with cardiac arrest
|
Helsinki, Finland
|
65
|
(a) Phenylephrine 1 mg or (b) epinephrine
0.5 mg intravenously
|
3% absolute increase in patients
with “successful” resuscitation
(NS)
|
|
Stueven et al. 1985a113
|
Cardiac arrest patients with asystole
as in Stueven et al. 1984109
|
Milwaukee, Wisconsin
|
73
|
(a) Calcium chloride or (b) saline
placebo
|
No long term survivors in either
group
|
|
Stueven et al. 1985b114
|
Cardiac arrest patients with electromechanical
dissociation who did not respond
to epinephrine and bicarbonate
|
Milwaukee, Wisconsin
|
90
|
(a) Calcium chloride or (b) saline
placebo
|
16% of patients receiving calcium
were admitted to the emergency department
with a pulse vs 5% of controls.
Only one patient was a long term
survivor.
|
|
Goldenberg et al. 1986115
|
Cardiac arrest patients
|
St. Paul, Minnesota
|
175
|
Airway managed with either (a)
esophageal gastric tube airway (EGTA)
or (b) endotracheal intubation (ETI)
|
Training in use of EGTA cost less
than ETI. Survival to hospital discharge
12.9% vs 11.1%.
|
|
Hargarten et al. 1986116
|
Stable patients with chest pain
|
Milwaukee, Wisconsin
|
446
|
(a) Lidocaine or (b) usual care
|
1.4% absolute decrease in hospital
mortality (NS). Four patients with
sudden death in each group (NS).
|
|
Mattox et al. 1986117
|
Injured patients with systolic
BP <90mm Hg
|
Houston, Texas
|
352
|
(a) Pneumatic antishock garments
or (b) usual care
|
No difference in mortality (NS).
|
|
Baxt and Moody 1987118
|
Trauma patients requiring resuscitation
transported by helicopter
|
San Diego, California
|
545
|
Helicopter staffed by (a) flight
nurse and paramedic or (b) flight
nurse and physician
|
Mortality of patients treated by
flight nurse / physician team was
lower than that of patients treated
by flight nurse / paramedic (p<0.05),
and lower than predicted by TRISS
(p<0.05)
|
|
Bickell et al. 1987119
|
Victims of gunshot or stab wounds
to anterior abdomen with a systolic
BP <90mm Hg
|
Houston, Texas
|
201
|
(a) Pneumatic antishock garments
or (b) usual care
|
8.8% absolute increase in
mortality at hospital discharge
(NS)
|
|
Castaigne et al. 1987120
|
Patients seen within three hours
of symptoms suggesting AMI who had
a qualifying ECG
|
Val de Marne, France
|
25
|
Administration by non-cardiologist
staffed mobile care unit of (a)
anisoylated plasminogen streptokinase
activator complex (APSAC) or (b)
placebo
|
Thrombolytic drug treatment started
56 minutes sooner after onset of
pain in mobile care unit group than
in control group.
|
|
Cummins et al. 1987121
|
Patients in cardiac arrest
|
Seattle, Washington
|
321
|
Use by EMT of (a) automated external
defibrillator (AED) or (b) standard
defibrillator
|
7% absolute reduction in mortality
at hospital discharge (NS). Time
from power on to first shock 0.9
minutes faster in AED group.
|
|
Hedges et al. 1987122
|
Patients in asystole or with hemodynamically
significant bradycardia
|
Thurston County, Washington
|
202
|
(a) Prehospital transcutaneous
cardiac pacing or (b) usual care
|
1.9% absolute reduction in mortality
at hospital discharge (NS)
|
|
Hoffman and Reynolds 1987123
|
Patients whose chief complaint
was dyspnea and who had a presumed
diagnosis of cardiogenic pulmonary
edema
|
Los Angeles County
|
57
|
Administration by paramedic of
(a) SL nitroglycerin and IV furosemide,
or (b) IV morphine and furosemide,
or (c) all three, or (d) IV morphine
and SL nitroglycerin
|
No difference at hospital discharge.
|
|
Barthell et al. 1988124
|
Patients in asystole or with hemodynamically
significant bradycardia
|
Milwaukee, Wisconsin
|
239
|
(a) External cardiac pacing device
or (b) usual care
|
2.4% absolute reduction in mortality
at hospital discharge (NS)
|
|
DuBoise-Rande et al. 1989125
Castaigne et al. 1989126
|
Patients seen within three hours
of symptoms who had a qualifying
ECG
|
Val de Marne, France
|
93
|
(a) Administration of APSAC by
anaesthesiologist staffed mobile
care unit or (b) inhospital treatment
|
0.3% (NS) reduction in mortality
in the prehospital group at hospital
discharge.
|
|
Krischer et al. 1989127
|
Adults with non-traumatic out of
hospital cardiac arrest
|
Florida
|
702
|
(a) Simultaneous compression-ventilation
(SC-V) CPR or (b) standard CPR
|
6.8% increase in mortality (p<0.01)
at hospital discharge
|
|
Mattox et al. 198950
|
Injured patients with systolic
BP <90mm Hg
|
Houston, Texas
|
911
|
(a) Pneumatic antishock garment
or (b) usual care
|
6% absolute increase in
mortality at hospital discharge
(p=0.05)
|
|
Olson et al. 1989128
|
Pulseless, nonbreathing patients
with initial cardiac rhythm of ventricular
fibrillation
|
Milwaukee, Wisconsin
|
102
|
Administration by paramedic of
repeated IV doses of (a) epinephrine
or (b) methoxamine
|
11.8% (NS) at hospital discharge
|
|
Barbash et al. 1990129
|
AMI patients seen within four hours
of symptoms who had a qualifying
ECG and confirmed for inclusion
by remote physician
|
Israel
|
87
|
(a) Administration of recombinant
tissue-type plasminogen activator
(rt-PA) by physician and paramedic
staffed mobile coronary care unit
or (b) inhospital treatment
|
4.5% (NS) reduction in mortality
in (a) at 60 days.
|
|
Hargarten et al. 1990130
|
Patients seen with symptoms suggestive
of AMI and confirmed for inclusion
by remote physician after ECG review
|
Milwaukee, Wisconsin
|
1,427
|
Administration by paramedic of
(a) IV lidocaine bolus and infusion
or (b) placebo
|
1.5% increase in mortality (NS)
at hospital discharge
|
|
Karagounis et al. 1990131
|
Patients clinically suspected of
having an AMI
|
Salt Lake City, Utah
|
71
|
(a) Prehospital cellular transmission
of 12-lead ECG or (b) no prehospital
ECG
|
In-field ECG caused negligible
delays in on-scene and transport
time
|
|
Roine et al. 1990132
|
Patients resuscitated from ventricular
fibrillation
|
Helsinki, Finland
|
155
|
(a) Initiation of IV nimodipine
10 mcg/kg with 24 hour infusion
or (b) placebo by physician staffed
advance life support unit
|
4% reduction in mortality at one
year in nimodipine group (NS)
|
|
Schofer et al. 1990133
Mathey et al. 1990134
|
AMI patients seen within four hours
of symptoms who had a qualifying
ECG
|
Hamburg, Germany
|
78
|
(a) Administration of IV urokinase
by physician and emergency medical
technician staffed mobile coronary
care unit or (b) inhospital treatment
|
2.8% (NS) reduction in mortality
in (a) at hospital discharge.
|
|
Mattox et al. 1991135
|
Trauma patients with systolic BP
<90mm Hg
|
Multicenter, USA
|
359
|
Administration of (a) 7.5% NaCl
with 6% Dextran or (b) lactated
Ringers
|
Absolute reduction in mortality
of 3.3% (NS); 7.5% NaCl/Dextran
significantly increased BP (p<0.05)
|
|
Risenfors et al. 1991136
|
AMI patients seen within 2.75 hours
of symptoms
|
Göteborg, Sweden
|