An article was published in this month’s Academic Emergency Medicine (AEM) titled, Prehospital Advanced Cardiac Life Support for Out-of-hospital Cardiac Arrest: A Cohort Study. Click the article title for free access on the AEM website.
This article by Cournoyer et al. asks if patients who are candidates for E-CPR in the out of hospital setting benefit from pre-hospital ACLS. That is, do we need pre-hospital ACLS crews, or is BLS adequate?
The primary outcome was survival to hospital discharge, while the secondary outcomes were pre-hospital ROSC and delay from call to hospital arrival. Unfortunately, they did not have adequate data to report another important outcome, survival with good neurologic outcome. This is arguably the most important patient oriented outcome for cardiac arrest studies.
Ultimately, this study showed no difference in survival to hospital discharge, though it did result in more pre-hospital ROSC. Here’s a nice visual representation by Kirsty Challen.
Does this sound familiar? It probably should. We can look back on Ian Stiell’s Ontario Pre-Hospital Advanced Life Support (OPALS) trial from the New England Journal in 2004 and see similar conclusions. Though the study design was different (Cohort vs. Before/After), ACLS still doesn’t seem to improve OHCA outcomes.
I strongly suggest you listen to the podcast and check out the blog over at the Skeptics’ Guide to Emergency Medicine by Ken Milne, with special guest Dr. Corey Heitz and Dr. Alexis Cournoyer, the lead author of this paper. They get into some of the details of the paper and bring up a good point regarding the external validity of this study, given that it was done in an urban setting.
A Twitter Poll was also posted by Ken, and seems to show that knowledge translation might be a bit of an issue with this paper.
Split nearly 50/50 that ACLS saves lives in OHCA. Hmmm. Looks like people need to head over to Ken’s blog and have a chat. The good news is that Dr. Cournoyer is also happy to answer any of your questions too, quite a rare opportunity.