According to a report published online by JAMA Internal Medicine, patients who had cardiac arrest outside of a hospital had greater survival to hospital discharge and to 90 days beyond if they received basic life support (BLS) versus advanced life support (ALS) from ambulance personnel.
For the study, Prachi Sanghavi, BS, and colleagues utilized data from a nationally representative sample of Medicare beneficiaries from non-rural counties in the United States who had out-of-hospital cardiac arrest between January 2009 and October 2011 for whom ALS or BLS ambulance services were charged to Medicare, as reported by Science Daily.
A total of 31,292 ALS cases and 1,643 BLS cases were examined, and researchers primarily focused on patient survival to hospital discharge to 30 days and 90 days. Results show survival to hospital discharge was greater among patients receiving BLS (13.1% versus 9.2% for ALS) as well as survival to 90 days post-discharge (8.0% versus 5.4% for ALS). The rates of poorer neurological functioning were lower for hospitalized patients who received BLS (21.8% versus 44.8% with poor neurological function for ALS).
The results suggest the difference in survival between ALS and BLS is explained by higher mortality in the first few days after cardiac arrest for patients who received ALS, according to researchers.
The study concludes, “Our study calls into question the widespread assumption that advanced pre-hospital 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.”
The study also notes, “It is crucial to evaluate BLS and ALS use in other diagnosis groups and setting and to investigate the clinical mechanisms behind our results to identify the most effective pre-hospital care strategies for saving lives and improving quality of life conditional on survival.”
Source: JAMA Internal Medicine