BLS better than ALS for cardiac arrests. Thoughts??

[avdrummerboy]

I'll just leave this here and see where it goes. I've always told my trainees and EMS students that BLS will save just as much life as ALS, just curious others thoughts.

http://www.sciencedaily.com/releases/2014/11/141124162922.htm

 

[Christopher]

That study is a prime example of: garbage in, garbage out.

1. OPALS came to this same conclusion in 2006. We learned way more from OPALS than this study.
2. The methodology of this study is nothing but hypothesis generating, and cannot tell you if BLS is better than ALS.
3. All this study reiterates is the outcome disparity across the US.
4. One of the authors said the best approach is to slap them on a stretcher and transport them to a hospital. (talk about a surefire way to reduce survival to discharge)

It is obvious the study authors are new to pre-hospital research because they would have realized how worthless their research question was otherwise! Let's take a huge database and mine it for outcomes based on the CMS reported LOS of the EMS crew. That sounds smart...until you realize what they've done: they've marginalized systems like King County, Wake County, or my own counties.

Compare their survival graphs against systems which are high performing and you'll note they're far better than the BLS average. In fact, not a single one of the high performing systems worldwide is BLS only. They all feature a system of care that starts with: early recognition, bystander CPR, dispatcher instructions, early BLS, high performance CPR, aggressive ALS, and a regionalized system of post-arrest cardiac arrest care.

 

[teedubbyaw]

. I've always told my trainees and EMS students that BLS will save just as much life as ALS,

That's a pretty broad statement. BLS will save lives in BLS calls.

As far as cardiac arrest, it's well proven that early CPR and defib are the key ingredients. Things change when there are clear reversible factors/causes, and during ROSC. Can BLS treat a bradycardic and severely hypotensive pt after they get a pulse back? No, so now your survivability rates have dropped and your neurological function/out of hospital recovery has dropped because of an ALS intervention that wasn't done.

Did not read article.

 

[avdrummerboy]

Early CPR and defibrillation are both BLS skills, if those are the key ingredients, then BLS is looking pretty good, I'm not sure I see your conundrum at that point. Post ROSC care absolutely should be ALS!!

 

[Christopher]

Early CPR and defibrillation are both BLS skills, if those are the key ingredients, then BLS is looking pretty good, I'm not sure I see your conundrum at that point. Post ROSC care absolutely should be ALS!!

Perhaps you misunderstand the point I'm making or the aim of the article. It is attempting to associate Ambulance Level of Service (CMS code) to Outcomes from OHCA. This quote captures the failure quite nicely (emphasis added):

"Our study calls into question the widespread assumption that advanced prehospital care improves outcomes of out-of-hospital cardiac arrest relative to care following the principles of BLS, including rapid transport and basic interventions such as effective chest compressions, bag valve mask ventilation and automated external defibrillation".

This study has not actually shown any of those points, but (ignoring that flaw) the fact that the authors would include "rapid transport" as a "principle" of BLS care for OHCA shows they have no clue what they're talking about. Nor have they compared any of those systems to those which are truly high performing.

Ambulance level of service as a correlate for Outcome is useless to system designers. The study has only shown that outcomes vary by zip code, and that overall outcomes are very poor.

King County uses a metric boatload of ALS procedures compared to your average BLS run-n-gun offered up by this article, and their stats blow the ones given in the article out of the water. Is this because the ALS procedures improve survival to discharge? Or is it because the BLS procedures improve survival to discharge?

Neither. Their survival to discharge is due to a bundle of treatments implemented as part of a system of care.

 

[ERDoc]

Only having read the abstract and not the full article I am left asking lots of questions. How long were the pts down before any interventions were started? Were the arrests witnessed or witnessed? How long was the pt in arrest prior to ROSC? Was there any cooling protocols used? I think there are just too many confounding variables that were not addressed (at least in the abstract) to make this study of any use, other than to say maybe we need to look into this a little further.

 

[Christopher]

Only having read the abstract and not the full article I am left asking lots of questions. How long were the pts down before any interventions were started? Were the arrests witnessed or witnessed? How long was the pt in arrest prior to ROSC? Was there any cooling protocols used? I think there are just too many confounding variables that were not addressed (at least in the abstract) to make this study of any use, other than to say maybe we need to look into this a little further.

That's just it though. They had no means of controlling for anything. Nothing of substance. No pre-hospital data. Just the billable level of service and the outcome in the hospital.

It is completely worthless to anyone looking to apply research to improve cardiac arrest outcomes.

 

[18G]

That's just it though. They had no means of controlling for anything. Nothing of substance. No pre-hospital data. Just the billable level of service and the outcome in the hospital.

It is completely worthless to anyone looking to apply research to improve cardiac arrest outcomes.

I had the same thoughts when I ready this study. I was taken back by the researchers comment of load and go is best for cardiac arrest patients... since when?

 

[TransportJockey]

Especially since studies have proven you can't effectively deliver chest compressions in a moving ambulance