Return to basics in ambulance cardiac arrest care, study suggests

A review of out-of-hospital cardiac arrest cases found that patients who received basic life support (BLS) in the ambulance had better survival and neurological performance compared with patients given advanced life support (ALS).

Harvard researchers compared ALS and BLS emergency medical services charged through Medicare between 2009 and 2011. Using Medicare data, Prachi Sanghavi, BS, of the Interfaculty Initiative in Health Policy at Harvard University in Cambridge, Mass., and colleagues were able to follow patient outcomes and obtain relative costs.

The findings were published online Nov. 24 in JAMA: Internal Medicine.

Although out-of-hospital cardiac arrest has a 90 percent annual mortality rate, the research team found that more patients receiving BLS survived to hospital discharge than ALS, 13.1 percent vs. 9.2 percent, respectively. Survival to 30 days favored BLS, 9.6 percent vs. 6.5 percent for ALS. At 90 days, BLS survival rates were around 8 percent with ALS around 5.4 percent.

Fewer BLS patients had poor neurological functioning after cardiac arrest; 6.1 percent of BLS patients had poor neurological outcomes vs. 9.7 percent of patients who had received ALS. At hospital admission, BLS patients were 23 percentage points lower than ALS when assessing rates of poor neurological function (21.8 vs. 44.8, respectively).

Mean medical spending was $2,778 higher among BLS patients, “in part because individuals who received BLS survived longer and had more opportunity to receive medical care,” Sanghavi wrote. However, at one year, BLS incremental spending per survivor cost $154,333 less than ALS survivors.

For Sanghavi et al, these findings show the need for a reassessment in transport care standards. “It is crucial to evaluate BLS and ALS use in other diagnosis groups and settings 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,” they wrote.

In an editorial response, Michael Callaham, MD, of the department of emergency medicine at the University of California, San Francisco, wrote that this data adds to a growing body of studies that suggest ALS is ineffective in most settings. “ALS resources could be redirected to produce demonstrable benefit in carefully selected patients. Using them where we know they will almost always fail is neither efficient nor ethical.”