Kurz MC, et al. - A comparison was performed of the association of advanced life support (ALS) care with out-of-hospital cardiac arrest (OHCA) outcomes using prospective clinical data from the Resuscitation Outcomes Consortium (ROC). When provided initially or within six minutes of basic life support (BLS) arrival, ALS care was noted to be associated with survival to hospital discharge. With or without initial BLS care, ALS care was associated with increased return of spontaneous circulation (ROSC), however, it was not associated with functional outcome.

Methods

• Researchers included consecutive adults OHCA treated by participating emergency medical services (EMS) agencies between June 1, 2011, and June 30, 2015.
• BLS was defined as receipt of cardiopulmonary resuscitation (CPR) and/or automated defibrillation and ALS was defined as receipt of an advanced airway, manual defibrillation, or intravenous drug therapy.
• Comparison of outcomes was performed among patients receiving: 1) BLS-only; 2) BLS + late ALS; 3) BLS + early ALS; and 4) ALS-first care.
• They used multivariable logistic regression to assess 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

• Researchers recognized 35,065 patients with OHCA.
• Characteristics of these patients 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.
• Outcomes suggested ALS care, with or without initial BLS care, to have independent association with increased adjusted ROSC and survival to hospital discharge unless delivered greater than 6 minutes after BLS arrival (BLS + late ALS).
• ALS care was not associated with significantly greater functional outcome regardless of when it was delivered.