Meta-analysis of published trials, 9 for trauma and 9 for non-trauma met their inclusion criteria after review, examining OR for survival when comparing ALS to BLS.
Trauma, unsurprisingly, derives no benefit from ALS in cardiac arrest. They even found a pooled OR of 0.89 for survival with ALS, but the CI just barely crosses 1.
But, contrary to the two most recently published prospective trials, their meta-analysis of non-trauma arrest still shows a survival benefit for ALS. They do include a few trials from before AEDs were available in BLS in 1995, but it still doesn’t explain the entire benefit. They also cite a few studies in which a physician is part of the paramedic team, which may mean there’s more to ALS than AHA ACLS, so that might be a bit of a confounder. Hard to know what to make of this data, considering the lack of demonstrable benefit from ACLS medications and the decreased survival of patients intubated in the field in out-of-hospital arrest.
My take is still that cardiac arrest, for the moment, is still a place where significant out-of-hospital resource investment is low yield, and CPR and AED is all they need en route to the ED.
We've stopped transporting without a pulse and have begun working all codes in the field. Emphasis on CPR and defibrillation. Our area has very poor bystander CPR and it takes 6-8 minutes for us to get there, so we don't have great numbers.
What some of the bigger NC counties have realized is that intubation is ok, as long as there are no interruptions to compressions. They've also pared down their code med list.
Impressive survival to discharge numbers using this technique and the opportunities for catastrophic failure (re: ambulance crash) is significantly decreased as needless code transports are eliminated.
Due to the chaotic nature of how prehospital medicine is practiced across the world (and the US) I think it is tough to tell exactly what to take from this study.
We've stopped transporting without a pulse and have begun working all codes in the field. Emphasis on CPR and defibrillation. Our area has very poor bystander CPR and it takes 6-8 minutes for us to get there, so we don't have great numbers.
What some of the bigger NC counties have realized is that intubation is ok, as long as there are no interruptions to compressions. They've also pared down their code med list.
Impressive survival to discharge numbers using this technique and the opportunities for catastrophic failure (re: ambulance crash) is significantly decreased as needless code transports are eliminated.
Due to the chaotic nature of how prehospital medicine is practiced across the world (and the US) I think it is tough to tell exactly what to take from this study.
CPR, shocks and…the best way to make your numbers improve is to transport fewer pulseless people to the ED. The amount of time EMS is out of service during and after a code transport is a huge waste of resources – resources that could be much better spend transporting the 19 year-old "feels sick"….
CPR, shocks and…the best way to make your numbers improve is to transport fewer pulseless people to the ED. The amount of time EMS is out of service during and after a code transport is a huge waste of resources – resources that could be much better spend transporting the 19 year-old "feels sick"….