Outcomes from out-of-hospital cardiac arrest in Metropolitan Taipei: Does an advanced life support service make a difference?
National Cheng Kung University Hospital, 臺南市, Taiwan, Taiwan Resuscitation
(Impact Factor: 4.17).
10/2007; 74(3):461-9. DOI: 10.1016/j.resuscitation.2007.02.006
Out-of-hospital cardiac arrest (OHCA) is of major medical and public health significance. It also serves as a good indicator in assessing the performance of local emergency medical services system (EMS). There have been arguments for and against the benefits of advanced life support (ALS) over basic life support with defibrillator (BLS-D) for treating OHCA.
The study was conducted to characterise the outcomes of cardiac arrest victims in an Asian metropolitan city; to evaluate the impacts of ALS versus BLS-D services; and to explore the possible patient and arrest factors that may be associated with the observed differences in the outcomes between the two pre-hospital care models.
Taipei is an Asian metropolitan city with an area of 272 km(2) and a population of 2.65 million. The fire-based BLS-D EMS system was in the process of phasing in ALS capability. While there were 40 BLS-D teams in the 12 city districts, two ALS teams were set up in the central part of the city. In this prospective study, all adult non-traumatic OHCA from September 2003 to August 2004 were included. Patient, arrest, care, and outcome variables for OHCA victims were collected from prehospital run sheets, automatic defibrillators, and emergency department and hospital records.
Among 1423 OHCA included in the analysis, 1037 (73%) received BLS-D service, and 386 (27%) received ALS services. The initial shockable rhythms and early bystander CPR were strongly associated with better survival for victims of cardiac arrests. Compared to BLS-D, ALS patients had similar age, sex, witness status, the rate of bystander CPR, and response timeliness but more patients in asystole (84% versus 72%, p=0.005). Patients treated by ALS were more likely to result in significantly higher rates of return of spontaneous circulation (29% versus 21%; OR=1.51 (95% CI 1.15-2.00); p=0.002) and survival to emergency department/intensive care unit admission (23% versus 15%; OR=1.66 (95% CI 1.22-2.24); p=0.001), but there was no difference in the rate of survival to hospital discharge (7% versus 5%; OR=1.39 (95% CI 0.84-2.23); p=0.17). The outcome difference from ALS services was more pronounced among patients in asystole and without bystander CPR.
In this metropolitan EMS in Asia, the implementation of ALS services improved the intermediate, but not the final outcomes. Communities with larger populations and lower incidence of initial shockable rhythms than the OPALS study should also prioritise their resources in setting up and optimising systems of basic life support and early defibrillations. Further studies are warranted to configure the optimal care model for combating cardiac arrest.
Available from: Amir Khorram-Manesh
- "In the former healthcare staffs are not qualified or authorized to intervene medically and follow the code of " scoop and run " , while in ALS, staffs have some qualifications to " stay and play " . Surprisingly, besides older reviews and some published expert opinions     , there is not enough scientific evidence to support ALS code in prehospital trauma           , cardiac and respiratory conditions         . Consequently, the need for higher competence than BLS in these cases has been questioned. "
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ABSTRACT: Objective: To evaluate the outcome of physician-staffed ambulances in a pilot study.
Methods: All physician-staffed ambulance missions conducted in Gothenburg, Sweden, in 2013
were retrospectively reviewed and evaluated for the type of missions and the need of a physician.
Results: Out of 1381 physician-staffed missions, 511 were cancelled or managed by telephone.
Around 239 (17%) missions required active intervention, of which only one was considered directly
Conclusions: Most of the missions neither required the interventional skills of a physician,
nor could they be performed at distance. However, the added medical value of physicians was
found to be in other prehospital situations, such as critical decision-making, staff education and
Available from: Heikki Pälve
- "Of the 46 studies there was one randomized controlled trial , 15 prospective follow-up studies [19,20,24,30,32,37-39,42,45,47,50,53,55,57] while the rest had a retrospective design. In the randomised trial  the effectiveness of prehospital thrombolysis and in-hospital thrombolysis for acute myocardial infarction was compared. "
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ABSTRACT: Prehospital care is classified into ALS- (advanced life support) and BLS- (basic life support) levels according to the methods used. ALS-level prehospital care uses invasive methods, such as intravenous fluids, medications and intubation. However, the effectiveness of ALS care compared to BLS has been questionable.
The aim of this systematic review is to compare the effectiveness of ALS- and BLS-level prehospital care.
In a systematic review, articles where ALS-level prehospital care was compared to BLS-level or any other treatment were included. The outcome variables were mortality or patient's health-related quality of life or patient's capacity to perform daily activities.
We identified 46 articles, mostly retrospective observational studies. The results on the effectiveness of ALS in unselected patient cohorts are contradictory. In cardiac arrest, early cardiopulmonary resuscitation and defibrillation are essential for survival, but prehospital ALS interventions have not improved survival. Prehospital thrombolytic treatment reduces mortality in patients having a myocardial infarction. The majority of research into trauma favours BLS in the case of penetrating trauma and also in cases of short distance to a hospital. In patients with severe head injuries, ALS provided by paramedics and intubation without anaesthesia can even be harmful. If the prehospital care is provided by an experienced physician and by a HEMS organisation (Helicopter Emergency Medical Service), ALS interventions may be beneficial for patients with multiple injuries and severe brain injuries. However, the results are contradictory.
ALS seems to improve survival in patients with myocardial infarction and BLS seems to be the proper level of care for patients with penetrating injuries. Some studies indicate a beneficial effect of ALS among patients with blunt head injuries or multiple injuries. There is also some evidence in favour of ALS among patients with epileptic seizures as well as those with a respiratory distress.
Available from: Yu-Jang Su
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ABSTRACT: SUMMARY Background: To investigate the characteristics of out-of-hospital cardiac arrest (OHCA) in the elderly, we retro- spectively studied a 6-month series of cases in an emergency department (ED) of a medical center in northern Taiwan. Methods: There were 145 OHCA cases sent to our ED from January 1, 2007 to June 30, 2007. Of these, 28 trauma- related and five pediatric cases were excluded, and 112 cases were eventually enrolled into our study. The 112 cases were divided into an elderly group (≥ 65 years) of 81 cases and a non-elderly group of 31 cases. There were 64 males and 48 females (male/female ratio, 1.33:1) aged 24-99 years. We collected the laboratory data and made comparisons between the elderly and non-elderly group in arterial blood gas, hemoglobin, potassium, glucose, and troponin I. We used the statistical software SPSS version 11.5.0 (SPSS Inc., Chicago, IL, USA) with t test analysis. The clinical significance was set at p < 0.05. Results: Return of spontaneous circulation (ROSC) occurred in 46 cases (41%) after standard resuscitation by advanced cardiac life support. The elderly group had a higher ROSC rate than the non-elderly group, but this was not significant (44% vs. 32%; p = 0.335). The elderly group had less acidosis, less hypercapnia, less hyper- kalemia, less hyperglycemia and a higher rate of elevated troponin I than the non-elderly group, but the differ- ences were not significant. The elderly group had significantly lower hemoglobin levels than the non-elderly group (10.52 ± 3.04 vs. 12.6 ± 3.32 g/dL; p = 0.003). The glucose levels of the ROSC group were significantly higher than the non-ROSC group in the elderly (230.14 ± 130.4 vs. 195.1 ± 147.7 mg/dL; p = 0.049). In the group of acute coro- nary syndrome (ACS)-related OHCA, the ROSC rate in the elderly group was significantly higher than that of the non-elderly (54.2% vs. 40%; p = 0.014). The elderly group had a slightly lower rate of survival than the non-elderly group (7.4% vs. 9.7%; p = 0.159). Conclusion: The elderly OHCA cases had an anemic status. The elderly had a higher ROSC rate in cases with relative hyperglycemia and ACS-related OHCA. This finding provides us with the theory of trialing administration of glucose water during resuscitation in OHCA cases. (International Journal of Gerontology 2008; 2(2): 67-71)
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