First up in the EMS news this week is a look at a story that got a lot of play in the new feeds of many of us last week. There was a Harvard retrospective study on the effectiveness of Advanced Life Support (ALS) versus Basic Life Support (BLS) care for patients in cardiac arrest. The authors of the study, published in JAMA Internal Medicine, looked at Medicare ambulance data from 2009 to 2011 on cardiac arrest transports and survival to discharge.
BLS Interventions Lead to Greater Survival
The researchers found that those patients who only received BLS interventions in the field were 50% more likely to survive to discharge than those who receive ALS interventions in the field. They surmise that this means that ALS care is harmful to cardiac arrest patients.
They define BLS care as CPR, defibrillation and basic airway management. ALS care includes IV access and intubation and other advanced airway procedures. There’s been a lot of commentary on this and related articles on the study. Here’s my take on this particular piece of research.
Problems With This Study
First, I think the data they collected is hopelessly out of date for most systems that have implemented the latest recommendations of the American Heart Associations Emergency Cardiac Care update. The renewed focus on basic, pit crew approach to CPR in cardiac arrest began with the 2010 ECC update that came out at the end of the year. So the data collected is from EMS systems using the previous set of cardiac guidelines.
Second, the study does not seem to allow for factors like bystander CPR, downtime before CPR, and whether it was a witnessed arrest or not. Patients in a witnessed arrest situation have a better chance of survival since BLS care would be started immediately along with early defibrillation before any advanced procedures would be attempted. In arrests with prolonged downtime, the arrested patients may get ROSC but required ALS interventions such as medications to correct medical issues. These patients would have ROSC but have a known poorer outcome.
I’m curious what you think. Read the linked article and then leave a comment back here on the show page and let me know if you agree with me or not. I look forward to hearing from you.
Follow up on the links to this news item and all the other articles and resources in this week’s episode show notes – Giving Meaning to EMS Data with NAEMT and Episode 414.