Outcomes After Out-of-Hospital Cardiac Arrest Treated by Basic vs Advanced Life Support ("...BLS had higher survival...")

JAMA Intern Med. 2014 Nov 24. doi: 10.1001/jamainternmed.2014.5420. [Epub ahead of print]

Outcomes After Out-of-Hospital Cardiac Arrest Treated by Basic vs Advanced Life Support.

Sanghavi P1, Jena AB2, Newhouse JP3, Zaslavsky AM4.

Author information

• 1Interfaculty Initiative in Health Policy, Harvard University, Cambridge, Massachusetts.
• 2Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts3Massachusetts General Hospital, Boston4National Bureau of Economic Research, Cambridge, Massachusetts.
• 3Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts4National Bureau of Economic Research, Cambridge, Massachusetts5Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts6Harvard Kenne.
• 4Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.

Abstract

IMPORTANCE:

Most out-of-hospital cardiac arrests receiving emergency medical services in the United States are treated by ambulance service providers trained in advanced life support (ALS), but supporting evidence for the use of ALS over basic life support (BLS) is limited.

OBJECTIVE:

To compare the effects of BLS and ALS on outcomes after out-of-hospital cardiac arrest.

DESIGN, SETTING, AND PARTICIPANTS:

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 1643 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.

MAIN OUTCOMES AND MEASURES:

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% 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). Basic life support 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 AND RELEVANCE:

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.