Hostname: page-component-76fb5796d-2lccl Total loading time: 0 Render date: 2024-04-27T03:08:10.436Z Has data issue: false hasContentIssue false
  • English
  • Français

The Efficacy of Advanced Life Support: A Review of the Literature

Published online by Cambridge University Press:  28 June 2012

Richard A. Bissell ,
Dawn Gyory Eslinger  and
Lynn Zimmerman
Richard A. Bissell*
Affiliation:
Department of Emergency Health Services, University of Maryland-Baltimore Campusand the National Study Center for Trauma and Emergency Medical Services, University of Maryland at Baltimore, Baltimore, Maryland, USA
Dawn Gyory Eslinger
Affiliation:
Department of Preventive Medicine and Epidemiology, University of Maryland at Baltimore, Baltimore, Maryland, USA
Lynn Zimmerman
Affiliation:
MedQuest, Inc., Grand Rapids, Michigan, USA
*
University of Maryland at Baltimore, School of Medicine, 701 West Pratt Street - 001, Baltimore, Maryland 21201-1023USA
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Jurisdictions throughout the United States and some other parts of the world have invested substantial time and resources into creating and sustaining a prehospital advanced life support (ALS) system without knowing whether the efficacy of ALS-level care had been validated scientifically. In recent years, it has become fashionable for speakers before large audiences to declare that there is no scientific evidence for the clinical effectiveness of ALS-level care in the out-of-hospital setting. This study was undertaken to evaluate the evidence that pertains to the efficacy of ALS-level care in the current scientific literature.

Methods:

An extensive review of the available literature was accomplished using computerized and manual means to identify all applicable articles from 1966 to October, 1995. Selected articles were read, abstracted, analyzed, and compiled Each article also was categorized as presenting evidence supporting or refuting the clinical efficacy of ALS-level care, and a list was constructed that pointed to where the preponderance of the evidence lies.

Results:

Research in this field differs widely in terms of methodological sophistication. Of the 51 articles reviewed, eight concluded that ALS-level care is not any more effective than is basic life support, seven concluded that it is effective in some applications but not for others, and the remainder demonstrated effectiveness. The strongest support for ALS-level care was in the area of responses to victims of cardiac arrest, whereas somewhat more divergent findings related to trauma or non condition-specific studies.

Conclusion:

While not unanimous, the predominant finding of recent research into the clinical effectiveness of advanced life support demonstrates improved effectiveness over basic life support for patients with certain pathologies. More outcomes-based research is needed.

Keywords

advanced life supportcardiac arrestcardiac emergencieseffectivenessefficacyemergency medical technicianliterature reviewparamedicprehospital emergency medical careseizuressupporttraumaventricular fibrillationventricular tachycardia
Type
Collective Review
Information
Prehospital and Disaster Medicine , Volume 13 , Issue 1 , March 1998 , pp. 69 - 79
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1998

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Jones, SE, Brenneis, AT: Study design in prehospital trauma advanced life support-basic life support research: A critical review. Annals of Emergency Medicine 1991;20:857–860.CrossRefGoogle ScholarPubMed
2. Spaite, D, Criss, E, Valenzuela, T, Guisto, J: Emergency medical service systems research: Problems of the past, challenges of the future. Annals of Emergency Medicine 1995;26:146–152.CrossRefGoogle ScholarPubMed
3. Pantridge, JF, Geddes, JS: A mobile intensive-care unit in the management of myocardial infarction. The Lancet 1967;2:271–273.CrossRefGoogle ScholarPubMed
4. Eisenberg, MS, Bergner, L, Hallstrom, A: Paramedic programs and out-of-hospital cardiac arrest: Factors associated with successful resuscitation. Am J Public Health 1979;69:30–38.CrossRefGoogle ScholarPubMed
5. Eisenberg, MS, Bergner, L, Hallstrom, A: Out-of-hospital cardiac arrest: Improved survival with paramedic services. Lancet 1980;1:812–815.CrossRefGoogle ScholarPubMed
6. Eisenberg, MS, Hallstrom, AP, Copass, MK et al. : Treatment of ventricular fibrillation emergency medical technician defibrillation and paramedic services. JAMA 1984;251:1723–1726.CrossRefGoogle ScholarPubMed
7. Cummins, RO, Ornato, JP, Thies, WH et al. : Improving survival from sudden cardiac arrest: The “chain of survival” concept. A statement for health professionals from the advanced cardiac life support subcommittee and the emergency cardiac care committee. American Heart Association. Circulation 1991;83:1832–1846.CrossRefGoogle ScholarPubMed
8. Eisenberg, MS, Horwood, BT, Cummins, RO et al. : Cardiac arrest and resuscitation: A tale of 29 cities. Annals of Emergency Medicine 1990;19:115–122.CrossRefGoogle ScholarPubMed
9. Eitel, DR, Walton, SL, Guerci, AD et al. : Out-of-hospital cardiac arrest: A six year experience in a suburban-rural system. Annals of Emergency Medicine 1988;17:75–79.CrossRefGoogle Scholar
10. Kellerman, AL, Hackman, BB, Somes, G et al. : Impact of first-responder defibrillation in an urban emergency medical system. JAMA 1993;270:1708–1713.CrossRefGoogle Scholar
11. Olson, DW, LaRochelle, J, Fark, D et al. : EMT-defibrillation: The Wisconsin experience. Annals of Emergency Medicine 1989;18:806–811.CrossRefGoogle ScholarPubMed
12. Larsen, MP, Eisenberg, MS, Cummins, RO et al. : Predicting survival from out-of-hospital cardiac arrest: A graphic model. Annals of Emergency Medicine 1993;22:1652–1658.CrossRefGoogle ScholarPubMed
13. Kellerman, AL, Hackman, BB, Somes, G: Predicting the outcome of unsuccessful prehospital advanced life support. JAMA 1993;270:1433–1436.CrossRefGoogle Scholar
14. Stults, KR, Brown, DD, Schug, VL: Prehospital defibrillation performed by emergency medical technicians in rural communities. New England Journal of Medicine 1984;310:219–223.CrossRefGoogle ScholarPubMed
15. Jacobs, IG, Oxer, HF: A review of prehospital defibrillation by ambulance officers in Perth, Western Austrialia. Medical Journal of Austrialia 1990;153:662–664.CrossRefGoogle Scholar
16. Shih, R, O'Connor, RE, Megargel, RE: Delaware emergency medical services system: Cardiac resuscitation. Delaware Medical Journal 1992;64:557–560.Google ScholarPubMed
17. Tillinghast, SJ, Doliszny, KM, Kottke, TE et al. : Change in survival from out-of-hospital cardiac arrest and its effect on coronary heart disease mortality, Minneapolis-St. Paul. The Minnesota Heart Survey. American Journal of Epidemiology 1991;134:851–861.CrossRefGoogle ScholarPubMed
18. Sweeney, TA, Dorn, MR: Resuscitation of cardiac arrest victims by advanced life support units in Monroe County, New York. New York State Journal of Medicine 1989; December, 652–654.Google Scholar
19. Pepe, PE, Bonnin, MJ, Clark, PS: Clinical predictors of survival in paramedic-witnessed cardiac arrest. Prehospital and Disaster Medicine 1989;4:71. (Abstract).Google Scholar
20. Pepe, PE, Bonnin, MJ, Almaguer, DR et al. : The effect of tiered system implementation on sudden death survival rates. Prehospital and Disaster Medicine 1989;4:71. (Abstract).Google Scholar
21. Pepe, PE, Bonnin, MJ, Mattox, KL: Regulating the scope of practice of EMS services. Prehospital and Disaster Medicine 1990;5:59–63.CrossRefGoogle Scholar
22. Aufderheide, T, Hendly, G, Thakur, R et al. : The diagnostic impact of prehospital 12-lead electrocardiography. Annals of Emergency Medicine 1990;19:1280–1287.CrossRefGoogle ScholarPubMed
23. Valenzuela, TD, Criss, EA, Spaite, D et al. : Cost-effectiveness analysis of paramedic emergency medical services in the treatment of prehospital cardiopulmonary arrest. Annals of Emergency Medicine 1990;19;1407–1411.CrossRefGoogle ScholarPubMed
24. Ornato, JP, Racht, EM, Fitch, JJ et al. : The need for ALS in urban and suburban EMS systems. Annals of Emergency Medicine 1990;19:1469–1470. (Editorial).CrossRefGoogle Scholar
25. Shuster, M, Keller, J, Shannon, H: Effects of prehospital care on outcome in patients with cardiac illness. Annals of Emergency Medicine 1995;26:138–145.CrossRefGoogle ScholarPubMed
26. Pressley, J, Severance, HW, Raney, MP: A comparison of paramedic versus basic emergency medical care of patients at high and low risk during acute myocardial infarction. Journal of the American College of Cardiology 1988;12:1555–1561.CrossRefGoogle ScholarPubMed
27. Wuerz, RC, Meador, SA: Effects of prehospital medications on mortality and length of stay in congestive heart failure. Annals of Emergency Medicine 1992;21:669–674.CrossRefGoogle ScholarPubMed
28. Dean, NC, Haug, PJ, Hawker, PJ: Effect of mobile paramedic units on outcome in patients with myocardial infarction. Annals of Emergency Medicine 1988;17:1034–1041.CrossRefGoogle ScholarPubMed
29. Tresch, DD, Fioretti, GP, Darin, JC, Brooks, HL: Out-of-hospital pulmonary edema: Diagnosis and treatment. Annals of Emergency Medicine 1983;12:533–537.CrossRefGoogle ScholarPubMed
30. Crampton, R: Prehospital advanced cardiac life support: Evaluation of a decade of experience. Topics in Emergency Medicine 1980;2:27–36Google Scholar
31. Fortner, GS, Oreskovich, MR, Compass, MK et al. : The effects of prehospital trauma care on survival from a 50-meter fall. Journal of Trauma 1983;23:976–981.CrossRefGoogle ScholarPubMed
32. Aprahamian, C, Thompson, BM, Towne, JB et al. : The effect of a paramedic system on mortality of major open intra-abdominal vascular trauma. Journal of Trauma 1983;23:687–690.CrossRefGoogle ScholarPubMed
33. Potter, D, Goldstein, G, Murray, S: A controlled trial of prehospital advanced life support in trauma. Annals of Emergency Medicine 1988;17:55–61.CrossRefGoogle ScholarPubMed
34. Cayten, CG, Longmore, W, Kuehl, A et al. : Basic life support vs. advanced life support for urban trauma. Journal of Trauma 1984;24:651. (Abstract).Google Scholar
35. Cayten, CG, Murphy, JG, Stahl, WM: Basic life support versus advanced life support for injured patients with an injury severity score of 10 or more. Journal of Trauma 1993;35:460–467.CrossRefGoogle ScholarPubMed
36. Gold, C: Prehospital advanced life support vs. “scoop and run” in trauma management. Annals of Emergency Medicine 1987;16:797–801.CrossRefGoogle ScholarPubMed
37. Smith, JP, Bodai, BI, Hill, AS et al. : Prehospital stabilization of critically injured patients: A failed concept. Journal of Trauma 1985;25:65–70.CrossRefGoogle ScholarPubMed
38. Kaweski, SM, Sise, MJ, Virgilio, RW: The effect of prehospital fluids on survival in trauma patients. Journal of Trauma 1990;30:1215–1219.CrossRefGoogle ScholarPubMed
39. Bickell, WH; Wall, MJ; Pepe, PE et al. : Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. New England Journal of Medicine 1994;331:1105–1109.CrossRefGoogle ScholarPubMed
40. Gervin, AS, Fischer, RP: The importance of prompt transport in salvage of patients with penetrating heart wounds. Journal of Trauma 1982;25:65–75.Google Scholar
41. Pepe, PE, Wyatt, CH, Bickell, WH et al. : The relationship between total prehospital time and outcome in hypotensive victims of penetrating injuries. Annals of Emergency Medicine 1987;16:293–297.CrossRefGoogle ScholarPubMed
42. Johnson, JC: Prehospital care: The future of emergency medical services. Annals of Emergency Medicine 1991;20:426–430.CrossRefGoogle ScholarPubMed
43. National Highway Traffic Safety Administration: EMS Agenda for the Future. Washington, DC, 1996.Google Scholar
44. Murphy, JG, Cayten, G, Stahl, WM et al. : Dual response runs in prehospital trauma care. Journal of Trauma 1993;35:356–362.CrossRefGoogle ScholarPubMed
45. Reines, HD, Bartlett, RL, Chudy, NE: Is advanced life support appropriate for victims of motor vehicle accidents: The South Carolina highway trauma project. Journal of Trauma 1988;28:563–570.CrossRefGoogle ScholarPubMed
46. Messick, WJ, Rutledge, R, Meyer, AA: The association of advanced life support training and decreased per capita trauma death rates: An analysis of 12,417 trauma deaths. Journal of Trauma 1992;33:850–855.CrossRefGoogle Scholar
47. Abarbanell, NR: Prehospital seizure management: Triage criteria for the advanced life support rescue team. American Journal of Emergency Medicine 1993;11:210–212.CrossRefGoogle Scholar
48. Andrews, RB, Brill, JC, Burns, RG et al. : Emergency medical services: A conceptual framework for the study of empirical influences of time and kind of treatment on outcomes for critical patients. Los Angeles Hospital Educational foundation of Southern California 1976.Google Scholar
49. Brill, JC, Geiderman, JM: A rationale for scoop-and-run identifying a subset of time-critical patients. Topics in Emergency Medicine 1981;3:37.Google Scholar
50. Sampalis, JS, Lavoie, A, Williams, AI et al. : Impact of on-site care, prehospital time, and level of in-hospital care on survival in severely injured patients. Journal of Trauma 1993;34:252–261.CrossRefGoogle ScholarPubMed
51. Cowley, RA: The resuscitation and stabilization of major multiple trauma patients in a trauma center environment. Clinical Medicine 1976;83:14–22.Google Scholar
52. Cowley, RA: A new concept for the delivery of critical care. Journal of the Medical Society of New Jersey 1977;74:979–986.Google ScholarPubMed
53. Weston, CFM, McCabe, MJ: Audit of an emergency ambulance service: Impact of a paramedic system. Journal of the Royal College of Physicians of London 1992;26:86–89.Google ScholarPubMed
54. Jacobs, LM, Sinclair, A, Beiser, A et al. : Prehospital advanced life support: benefits in trauma. Journal of Trauma 1984;24:8–13.CrossRefGoogle ScholarPubMed
55. Shuster, M, Shannon, HS: Differential prehospital benefit from paramedic care. Annals of Emergency Medicine 1994;23:1014–1021.CrossRefGoogle ScholarPubMed
56. Wilson, B, Gratton, MC, Overton, J, Watson, W.A.: Unexpected ALS procedures on non-emergency ambulance calls: The value of a single-tier system. Prehospital and Disaster Medicine 1992;7:380–382.CrossRefGoogle Scholar
57. Maio, RF, Spaite, D: Using epidemiologic methods to evaluate out-of-hospital care: The ecologic study. Annals of Emergency Medicine 1995;26:153–157.CrossRefGoogle ScholarPubMed