Hostname: page-component-848d4c4894-ttngx Total loading time: 0 Render date: 2024-05-09T18:01:19.052Z Has data issue: false hasContentIssue false
  • English
  • Français

Does Advanced Life Support Provide Benefits to Patients?: A Literature Review

Published online by Cambridge University Press:  28 June 2012

Derek L. Isenberg  and
Richard Bissell
Derek L. Isenberg*
Affiliation:
Tulane School of Medicine New Orleans, Louisiana, USA
Richard Bissell
Affiliation:
National Center for Trauma and Emergency Medical Services, University of Maryland-Baltimore County, Baltimore, Maryland, USA
*
Tulane School of Medicine, 1430 Tulane Ave., Box F19 New Orleans, LA 70112, USA E-mail: disenber@tulane.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Emergency medical services have invested substantial resources to establish advanced life support (ALS) programs. However, it is unclear whether ALS care provides better outcomes to patients compared to basic life support (BLS) care.

Objective:

To evaluate the current evidence regarding the benefits of ALS.

Methods:

Electronic medical databases were searched to identify articles that directly compared ALS versus BLS care. A total of 455 articles were found. Articles were excluded for the following reasons: (1) the article was not written in English; (2) BLS response was not compared to an ALS response; (3) a physician or nurse was included as part of the ALS response; (4) it was an aeromedical response; or (5) defibrillation was included in the ALS, but not the BLS, scope of care. Twenty-one articles met the inclusion criteria for this literature review.

Results:

Results were divided into four categories: (1) trauma; (2) cardiac arrest; (3) myocardial infarction; and (4) altered mental status.

Trauma:

The majority of articles showed that ALS provided no benefits over BLS in urban trauma patients. In fact, most studies showed higher mortality rates for trauma patients receiving ALS care. Further research is needed to evaluate the benefits of ALS for rural trauma patients, and whether ALS care improves outcomes in subgroups of urban trauma patients.

Cardiac Arrest:

Cardiac arrest studies show that early CPR plus early defibrillation provide the greatest improvement in survival. However, most cardiac arrest research includes defibrillation as an ALS skill which has now moved into the BLS scope of care. The 2004 multi-center OPALS study provided good evidence that ALS does not improve cardiac arrest survival over early defibrillation. Further research is needed to address whether any ALS interventions improve cardiac arrest outcome.

Myocardial Infarction:

Only one study directly compared the outcome of BLS and ALS care on myocardial infarction. The study found no difference in outcomes between BLS and ALS care in an urban setting.

Advanced Life Support:

Only one study directly compared the outcome of BLS and ALS care on patients with altered mental status. The study found that the same number of patients had improved to “alert” on arrival at the emergency department, but there was a decreased length of emergency department stay for patients treated by ALS for hypoglycemia.

Limitations:

This review article does not take into account the benefits of ALS interventions, such as thrombolytics, dextrose, or nitroglycerin, since no studies directly compared these interventions to BLS care. Furthermore, only one study in this literature review was a large, multi-center trial.

Conclusions:

ALS shows little, if any, benefits for urban trauma patients. Cardiac arrest studies show that ALS does not provide additional benefits over BLS-defibrillation care, but more research is needed in this area. In two small studies, ALS care did not provide benefits over BLS care for patients with myocardial infarctions or altered mental status. Larger-scale studies are needed to evaluate which specific ALS interventions improve patient outcomes.

Keywords

advanced life support (ALS)basic life support (BLS)benefitscardiac arrestevaluationpatientsmyocardial infarctiontrauma
Type
Comprehensive Review
Information
Prehospital and Disaster Medicine , Volume 20 , Issue 4 , August 2005 , pp. 265 - 270
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2005

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

1Bissell, RA, Eslinger, DG, Zimmeraman, L: The efficacy of advanced life support: A review of the literature. Prehosp Disast Med 1997;13(1)77–87.Google Scholar
2Stiell, IG, Well, GA, Field, B et al,: Advanced cardiac life support in out-of-hospital cardiac arrest. N Engl J Med 2004 (351), 647–656.Google Scholar
3National Highway and Transportation Safety Administration: Emergency Medical Technician-Intermediate: National Standard Curriculum. Washington, DC: U.S. Government Printing Office, 1999.Google Scholar
4National Highway and Transportation Safety Administration: Emergency Medical Technician-Paramedic: National Standard Curriculum. Washington, DC: U.S. Government Printing Office, 1998.Google Scholar
5Jacobs, LM, Sinclair, A, Beiser, A, D'Agostino, RB: Prehospital advanced life support: Benefits in trauma. Journal of Trauma-Injury Infection & Critical Care 1984;24(1)8–13.CrossRefGoogle ScholarPubMed
6Potter, D, Goldstein, G, Fung, SC, Selig, M: A controlled trial of prehospital advanced life support in trauma. Ann Emerg Med 1988;17(6)582–588.CrossRefGoogle ScholarPubMed
7Murphy, JG, Cayten, CG, Stahl, WM, Glasser, M: Dual response runs in pre-hospital trauma care. Journal of Trauma-Injury Infection & Critical Care 1993;35(3)356–362.CrossRefGoogle Scholar
8Sampalis, JS, Lavoie, A, Williams, JI, Mulder, DS, Kalina, M: Impact of on-site care, prehospital time, and level of in-hospital care on survival in severely injured patients. Journal of Trauma-Injury Infection & Critical Care 1993;34(2)252–261.CrossRefGoogle ScholarPubMed
9Cayten, 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-Injury Infection & Critical Care 1993;35(3)460–466.CrossRefGoogle ScholarPubMed
10Eckstein, M, Chan, L, Schneir, A, Palmer, R: Effect of prehospital advanced life support on outcomes of major trauma patients. Journal of Trauma-Injury Infection & Critical Care 2000;48(4)643–648.CrossRefGoogle ScholarPubMed
11Liberman, M, Mulder, D, Sampalis, J: Advanced or basic life support for trauma: Meta-analysis and critical review of the literature. J Trauma 2000; 49(4):584–599.CrossRefGoogle Scholar
12Liberman, M, Mulder, D, Lavoie, A et al,: Multicenter Canadian study of pre-hospital trauma care. Ann Surg 2003;237(2)153–160.CrossRefGoogle Scholar
13Svenson, JE, Spurlock, C., Nypaver, M: Factors associated with the higher traumatic death rate among rural children. Ann Emerg Med 1996;27(5): 625–632.CrossRefGoogle ScholarPubMed
14Rutledge, R, Smith, CY, Azizkhank, RG: A population-based multivariate analysis of the association of county demographic and medical system factors with per capita pediatric trauma death rates in North Carolina. Ann Surg 1994;219(2)205–210.CrossRefGoogle ScholarPubMed
15Reines, HD, Bartlett, RL, Chudy, NE et al,: Is advanced life support appropriate for victims of motor vehicle accidents: The South Carolina Highway Trauma Project. Journal of Trauma-Injury Infection & Critical Care 1998;28(5)563–570.CrossRefGoogle Scholar
16Messick, 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-Injury Infection & Critical Care 1992;33(6)850–855.CrossRefGoogle ScholarPubMed
17Rutledge, R, Messick, J, Baker, CC et al,: Multivariate population-based analysis of the association of county trauma centers with per capita county trauma death rates. Journal of Trauma-Injury Infection & Critical Care 1992; 33(1):29–37.CrossRefGoogle ScholarPubMed
18Alexander, RH, Pons, PT, Krischer, J, Hunt, P: The effect of advanced life support and sophisticated hospital systems on motor vehicle mortality. Journal of Trauma-Injury Infection & Critical Care 1984;24(6)486–490.CrossRefGoogle ScholarPubMed
19Cayten, 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-Injury Infection & Critical Care 1993;35(3):460.CrossRefGoogle ScholarPubMed
20Eisen, JS, Dubinsky, I: Advanced life support vs. basic life support field care: An outcome study. Acad Emerg Med 1998;5(6)592–598.CrossRefGoogle ScholarPubMed
21Rainer, TH, Marshall, R, Cusack, S: Paramedics, technicians, and survival from out-of-hospital cardiac arrest. J Accid Emerg Med 1997;14(5)278–282.CrossRefGoogle ScholarPubMed
22Adams, JN, Sirel, J, Marsden, K, Cobbe, SM: Heartstart Scotland: The use of paramedic skills in out-of-hospital resuscitation. Heart 1997;78(4)399–402.CrossRefGoogle ScholarPubMed
23Pitetti, R, Glustein, JZ, Bhende, MS: Prehospital care and outcome of pediatric out-of-hospital cardiac arrest. Prehosp Emerg Care 2002;6(3)283–290.CrossRefGoogle ScholarPubMed
24American Heart Association: BLS for Healthcare Providers. Dallas: American Heart Association, 2001, pp 90–121.Google Scholar
25Shuster, M, Keller, J, Shannon, H: Effects of prehospital care on outcome in patients with cardiac illness. Ann Emerg Med 1995;26(2)138–145.CrossRefGoogle ScholarPubMed
26Adams, J, Aldag, G, Wolford, R: Does the level of prehospital care influence the outcome of patients with altered levels of consciousness? Prehosp Disast Med 1996;11(2)101–104.CrossRefGoogle ScholarPubMed
27Saver, JL, Kidwell, C., Eckstein, M, Starkman, S, for the FAST-MAG Pilot Trial Investigators: Prehospital neuroprotective therapy for acute stroke Results of the Field Administration of Stroke Therapy-Magnesium (FAST-MAG) pilot trial. Stroke 2004;35(5):e106–e108.CrossRefGoogle ScholarPubMed
28Morrow, DA, Antman, EM, Sayah, A et al,: Evaluation of the time saved by prehospital initiation of reteplase for ST-elevation myocardial infarction: Results of the Early Retavase-Thrombolysis in Myocardial Infarction (ERTIMI) trial. J Am Coll Cardiol 2002;40(1)71–73.CrossRefGoogle ScholarPubMed
29Pedley, DK, Bissett, K, Connolly, EM et al,: Prospective observational cohort study of time saved by prehospital thrombolysis for ST elevation myocardial infarction delivered by paramedics. BMJ 2003;327(7405)22–26.CrossRefGoogle ScholarPubMed