Advanced vs. Basic Life Support in the Treatment of Out-of-Hospital Cardiopulmonary Arrest in the Resuscitation Outcomes Consortium

RESUSCITATION

卷:128

Article

Kurz, Michael Christopher¹  Schmicker, Robert H.²  Leroux, Brian²  Nichol, Graham³  Aufderheide, Tom P.⁴  Cheskes, Sheldon^5,6  Grunau, Brian⁷  Jasti, Jamie⁴  Kudenchuk, Peter⁸  Vilke, Gary M.⁹  Buick, Jason⁴  Wittwer, Lynn¹⁰  Sahni, Ritu¹¹  Straight, Ronald^12,13  Wang, Henry E.¹⁴ 

[1] Univ Alabama Birmingham, Dept Emergency Med, OHB 251,619 19th ST S, Birmingham, AL 35249 USA

[2] Univ Washington, Dept Biostat, Clin Trial Ctr, Seattle, WA 98195 USA

[3] Univ Washington, Harborview Ctr Prehospital Emergency Care, Seattle, WA 98195 USA

[4] Med Coll Wisconsin, Dept Emergency Med, Milwaukee, WI 53226 USA

[5] St Michaels Hosp, Li Ka Shing Knowledge Inst, Keenan Res Ctr, Rescu, Toronto, ON, Canada

[6] Univ Toronto, Div Emergency Med, Dept Family Community Med, Toronto, ON, Canada

[7] Univ British Columbia, Dept Emergency Med, Fac Med, Vancouver, BC, Canada

[8] Univ Washington, Dept Med, Div Cardiol, Seattle, WA USA

[9] Univ Calif San Diego, Dept Emergency Med, San Diego, CA 92103 USA

[10] Clark Cty Emergency Med Serv, Vancouver, WA USA

[11] Oregon Hlth & Sci Univ, Dept Emergency Med, Portland, OR 97201 USA

[12] Providence Hlth Care Res Inst, Vancouver, BC, Canada

[13] British Columbia Emergency Hlth Serv, Vancouver, BC, Canada

[14] Univ Texas Hlth Sci Ctr Houston, Dept Emergency Med, Houston, TX 77030 USA

关键词: Cardiac arrest;    Advanced life support;    Basic life support;    Emergency medical services;    Cardiopulmonary resuscitation;   

DOI  :  10.1016/j.resuscitation.2018.04.031

来源: Elsevier

【 摘 要 】

Background: Prior observational studies suggest no additional benefit from advanced life support (ALS) when compared with providing basic life support (BLS) for patients with out-of-hospital cardiac arrest (OHCA). We compared the association of ALS care with OHCA outcomes using prospective clinical data from the Resuscitation Outcomes Consortium (ROC). Methods: Included were consecutive adults OHCA treated by participating emergency medical services (EMS) agencies between June 1, 2011, and June 30, 2015. We defined BLS as receipt of cardiopulmonary resuscitation (CPR) and/or automated defibrillation and ALS as receipt of an advanced airway, manual defibrillation, or intravenous drug therapy. We compared outcomes among patients receiving: 1) BLS-only; 2) BLS + late ALS; 3) BLS+ early ALS; and 4) ALS-first care. Using multivariable logistic regression, we evaluated the associations between level of care and return of spontaneous circulation (ROSC), survival to hospital discharge, and survival with good functional status, adjusting for age, sex, witnessed arrest, bystander CPR, shockable initial rhythm, public location, EMS response time, CPR quality, and ROC site. Results: Among 35,065 patients with OHCA, characteristics were median age 68 years (IQR 56-80), male 63.9%, witnessed arrest 43.8%, bystander CPR 50.6%, and shockable initial rhythm 24.2%. Care delivered was: 4.0% BLS-only, 31.5% BLS + late ALS, 17.2% BLS + early ALS, and 47.3% ALS-first. ALS care with or without initial BLS care was independently associated with increased adjusted ROSC and survival to hospital discharge unless delivered greater than 6 min after BLS arrival (BLS+ late ALS). Regardless of when it was delivered, ALS care was not associated with significantly greater functional outcome. Conclusion: ALS care was associated with survival to hospital discharge when provided initially or within six minutes of BLS arrival. ALS care, with or without initial BLS care, was associated with increased ROSC, however it was not associated with functional outcome.

【 授权许可】

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