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Outcomes After Out-of-Hospital Cardiac Arrest Treated by BLS vs. ALS | Journal Scan
Study Questions:
What are the effects of basic life support (BLS) and advanced life support (ALS) on outcomes after out-of-hospital cardiac arrest?
Methods:
This was an observational cohort study of a nationally representative sample of traditional Medicare beneficiaries from nonrural counties who experienced out-of-hospital cardiac arrest between January 1, 2009, and October 2, 2011, and for whom ALS or BLS ambulance services were billed to Medicare (31,292 ALS cases and 1,643 BLS cases). Propensity score methods were used to compare the effects of ALS and BLS on patient survival, neurological performance, and medical spending after cardiac arrest. The main outcomes measures were survival to hospital discharge, to 30 days, and to 90 days; neurological performance; and incremental medical spending per additional survivor to 1 year.
Results:
Survival to hospital discharge was greater among patients receiving BLS (13.1% vs. 9.2% for ALS; 4.0 [95% confidence interval (CI), 2.3-5.7] percentage point difference), as was survival to 90 days (8.0% vs 5.4% for ALS; 2.6 [95% CI, 1.2-4.0] percentage point difference). BLS was associated with better neurological functioning among hospitalized patients (21.8% vs. 44.8% with poor neurological functioning for ALS; 23.0 [95% CI, 18.6-27.4] percentage point difference). Incremental medical spending per additional survivor to 1 year for BLS relative to ALS was $154,333.
Conclusions:
The authors concluded that patients with out-of-hospital cardiac arrest who received BLS had higher survival at hospital discharge and at 90 days compared with those who received ALS, and were less likely to experience poor neurological functioning.
Perspective:
This study reports that patients with out-of-hospital cardiac arrest who received BLS had higher survival compared with those who received ALS, and calls into question the widespread assumption that advanced prehospital care improves outcomes of out-of-hospital cardiac arrest relative to care following the principles of BLS, including rapid transport and basic interventions such as effective chest compressions, bag valve mask ventilation, and automated external defibrillation. It will be important to evaluate BLS and ALS use in other groups and settings, and to investigate the clinical mechanisms behind these results to identify the most effective prehospital resuscitation care strategies for saving lives and improving quality of life conditional on survival.
Keywords: Heart Arrest, Out-of-Hospital Cardiac Arrest, Defibrillators, Implantable, Medicare, Cohort Studies, Propensity Score, Resuscitation, Survival, Advanced Cardiac Life Support
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