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

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.

Sex and age specific time patterns and long term time trends of pre-hospital delay of patients presenting with acute ST-segment elevation myocardial infarction

“…However, against expectation, the pre-hospital time (transportation time) in emergency service users remained stable over the observation period while the delay time increased in those who were not admitted by emergency services to the hospital. Apparently, the implementation of advanced life support programs did not cause time-to-door [33] deficits.…”

Outcomes of Basic Versus Advanced Life Support for Out-of-Hospital Medical Emergencies

“…Prior studies, mostly from outside the United States, show evidence of similar or longer survival associated with BLS (2–5, 7, 9–16). But with few exceptions, these studies are limited by small sample sizes and lack of adjustment for key confounders.…”

Outcomes After Out-of-Hospital Cardiac Arrest Treated by Basic vs Advanced Life Support

“…10,12 Of the few high-quality comparisons that exist, the most robust is a before-after study 10 from Ontario, Canada, which found that ALS did not improve survival to hospital discharge compared with a BLS system that optimized the time to defibrillation. Research from the United States is scant, but observational studies 13,14 from urban areas of other high-income countries have also failed to find a benefit of prehospital ALS.…”