Advanced life support versus basic life support in the pre-hospital setting: A meta-analysis

BackgroundOur objective was to perform a systematic review of studies reporting the accuracy of termination of resuscitation rules (TORRs) for out-of-hospital cardiac arrest (OHCA).MethodsWe performed a comprehensive search of the literature for studies evaluating the accuracy of TORRs, with two investigators abstracting relevant data from each study regarding study design, study quality and the accuracy of the TORRs. Bivariate meta-analysis was performed using the mada procedure in R.ResultsWe identified 14 studies reporting the performance of 9 separate TORRs. The sensitivity (proportion of eventual survivors for whom the TORR recommends resuscitation and transport) was generally high: 95% for the European Resuscitation Council (ERC) TORR, 97% for the basic life support (BLS) TORR and 99% for the advanced life support (ALS) TORR. The BLS and ERC TORR were more specific, which would lead to fewer futile transports, and all three of these TORRs had a miss rate of ≤0.13% (defined as a case where a patient is recommended for termination but survives). The pooled proportion of patients for whom each rule recommends TOR was much higher for the ERC and BLS TORRs (93.5% and 74.8%, respectively) than for the ALS TORR (29.0%).ConclusionsThe BLS and ERC TORRs identify a large proportion of patients who are candidates for termination of resuscitation following OHCA while having a very low rate of misclassifying eventual survivors (<0.1%). Further prospective validation of the ERC TORR and direct comparison with BLS TORR are needed.

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The Efficacy of Advanced Life Support: A Review of the Literature

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00033070 ◽

1998 ◽

Vol 13 (1) ◽

pp. 69-79 ◽

Cited By ~ 23

Author(s):

Richard A. Bissell ◽

Dawn Gyory Eslinger ◽

Lynn Zimmerman

Keyword(s):

Basic Life Support ◽

Life Support ◽

Scientific Literature ◽

Scientific Evidence ◽

Hospital Setting ◽

Advanced Life Support ◽

Clinical Effectiveness ◽

The United States ◽

Review Of The Literature ◽

The World

AbstractIntroduction:Jurisdictions throughout the United States and some other parts of the world have invested substantial time and resources into creating and sustaining a prehospital advanced life support (ALS) system without knowing whether the efficacy of ALS-level care had been validated scientifically. In recent years, it has become fashionable for speakers before large audiences to declare that there is no scientific evidence for the clinical effectiveness of ALS-level care in the out-of-hospital setting. This study was undertaken to evaluate the evidence that pertains to the efficacy of ALS-level care in the current scientific literature.Methods:An extensive review of the available literature was accomplished using computerized and manual means to identify all applicable articles from 1966 to October, 1995. Selected articles were read, abstracted, analyzed, and compiled Each article also was categorized as presenting evidence supporting or refuting the clinical efficacy of ALS-level care, and a list was constructed that pointed to where the preponderance of the evidence lies.Results:Research in this field differs widely in terms of methodological sophistication. Of the 51 articles reviewed, eight concluded that ALS-level care is not any more effective than is basic life support, seven concluded that it is effective in some applications but not for others, and the remainder demonstrated effectiveness. The strongest support for ALS-level care was in the area of responses to victims of cardiac arrest, whereas somewhat more divergent findings related to trauma or non condition-specific studies.Conclusion:While not unanimous, the predominant finding of recent research into the clinical effectiveness of advanced life support demonstrates improved effectiveness over basic life support for patients with certain pathologies. More outcomes-based research is needed.

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Advanced Life Support vs. Basic Life Support for Patients With Trauma in Prehospital Settings: A Systematic Review and Meta-Analysis

Frontiers in Medicine ◽

10.3389/fmed.2021.660367 ◽

2021 ◽

Vol 8 ◽

Author(s):

Yutaka Kondo ◽

Tatsuma Fukuda ◽

Ryo Uchimido ◽

Masahiro Kashiura ◽

Soichiro Kato ◽

...

Keyword(s):

Observational Studies ◽

Basic Life Support ◽

Life Support ◽

Meta Analysis ◽

Advanced Life Support ◽

Mean Difference ◽

Controlled Trials ◽

Trauma Patients ◽

Cochrane Central Register ◽

Neurological Outcomes

Background: Advanced Life Support (ALS) is regarded to be associated with improved survival in pre-hospital trauma care when compared to Basic Life Support (BLS) irrespective of lack of evidence. The aim of this study is to ascertain ALS improves survival for trauma in prehospital settings when compared to BLS.Methods: We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials for published controlled trials (CTs), and observational studies that were published until Aug 2017. The population of interest were adults (>18 years old) trauma patients who were transported by ground transportation and required resuscitation in prehospital settings. We compared outcomes between the ALS and BLS groups. The primary outcome was in-hospital mortality and secondary outcomes were neurological outcome and time spent on scene.Results: We identified 2,502 studies from various databases and 10 studies were included in the analysis (two CTs, and eight observational studies). The outcomes were not statistically significant between the ALS and BLS groups (pooled OR 1.14; 95% CI 0.95 to 1.36 for mortality, pooled OR 1.12; 95% CI 0.88 to 1.42 for good neurological outcomes, pooled mean difference −0.96; 95% CI−6.64 to 4.72 for on-scene time) in CTs. In observational studies, ALS prolonged on-scene time and increased mortality (pooled OR 1.56; 95% CI: 1.31 to 1.86 for mortality, and pooled mean difference, 1.26; 95% CI: 0.07 to 2.45 for on-scene time).Conclusions: In prehospital settings, the present study showed no advantages of ALS on the outcomes in patients with trauma compared to BLS.

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Effects of advanced life support versus basic life support on the mortality rates of patients with trauma in prehospital settings: a study protocol for a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2017-016912 ◽

2017 ◽

Vol 7 (10) ◽

pp. e016912 ◽

Cited By ~ 3

Author(s):

Yutaka Kondo ◽

Tatsuma Fukuda ◽

Ryo Uchimido ◽

Toru Hifumi ◽

Kei Hayashida

Keyword(s):

Systematic Review ◽

Basic Life Support ◽

Life Support ◽

Meta Analysis ◽

Advanced Life Support ◽

Controlled Trials ◽

Cochrane Central Register ◽

Evaluation Approach ◽

Registration Number ◽

Randomised Controlled

IntroductionAdvanced life support (ALS) is thought to be associated with improved survival in prehospital trauma care when compared with basic life support (BLS). However, evidence on the benefits of prehospital ALS for patients with trauma is controversial. Therefore, we aim to clarify if ALS improves mortality in patients with trauma when compared with BLS by conducting a systematic review and meta-analysis of the recent literature.Methods and analysisWe will perform searches in PubMed, Embase and the Cochrane Central Register of Controlled Trials for published observational studies, controlled before-and-after studies, randomised controlled trials and other controlled trials conducted in humans and published until March 2017. We will screen search results, assess study selection, extract data and assess the risk of bias in duplicate; disagreements will be resolved through discussions. Data from clinically homogeneous studies will be pooled using a random-effects meta-analysis, heterogeneity of effects will be assessed using the χ2test of homogeneity, and any observed heterogeneity will be quantified using the I2statistic. Last, the Grading of Recommendations Assessment, Development and Evaluation approach will be used to rate the quality of the evidence.Ethics and disseminationOur study does not require ethical approval as it is based on findings of previously published articles. Results will be disseminated through publication in a peer-reviewed journal, presentations at relevant conferences and publications for patient information.Trial registration numberPROSPERO (International Prospective Register of Systematic Reviews) registration number CRD42017054389.

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Recommended Essential Equipment for Basic Life Support and Advanced Life Support Ground Ambulances 2020: A Joint Position Statement

Prehospital Emergency Care ◽

10.1080/10903127.2021.1886382 ◽

2021 ◽

pp. 1-9

Author(s):

John Lyng ◽

Kathleen Adelgais ◽

Rachael Alter ◽

Justin Beal ◽

Bruce Chung ◽

...

Keyword(s):

Basic Life Support ◽

Life Support ◽

Advanced Life Support ◽

Position Statement ◽

Joint Position ◽

Ground Ambulances

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Part 6: Pediatric basic life support and pediatric advanced life support

Resuscitation ◽

10.1016/j.resuscitation.2015.07.044 ◽

2015 ◽

Vol 95 ◽

pp. e147-e168 ◽

Cited By ~ 66

Author(s):

Ian K. Maconochie ◽

Allan R. de Caen ◽

Richard Aickin ◽

Dianne L. Atkins ◽

Dominique Biarent ◽

...

Keyword(s):

Basic Life Support ◽

Life Support ◽

Advanced Life Support

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Basic life support and advanced life support

Get Through Clinical Finals: A Toolkit for OSCEs ◽

10.1201/b13262-41 ◽

2006 ◽

pp. 241-248

Keyword(s):

Basic Life Support ◽

Life Support ◽

Advanced Life Support

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ПРАКТИЧНІ НАВИЧКИ ДЛЯ ЛІКАРІВ НА КАФЕДРІ МЕДИЦИНИ НЕВІДКЛАДНИХ СТАНІВ: ОПТИМІЗАЦІЯ МЕТОДИКИ ВИКЛАДАННЯ

Медична освіта ◽

10.11603/me.2414-5998.2019.3.10129 ◽

2019 ◽

pp. 71-73

Author(s):

A. O. Volosovets ◽

B. I. Slonetsky ◽

I. S. Zozulya ◽

A. I. Zozulya ◽

V. I. Bobrova

Keyword(s):

Basic Life Support ◽

Life Support ◽

Advanced Life Support

Мета роботи – оптимізувати викладання та розподіл алгоритмів виконання практичних навичок лікарями медицини невідкладних станів на догоспітальному та ранньому госпітальному етапах згідно з сучасними стандартами надання невідкладної медичної допомоги. Основна частина. Для реалізації та адекватного інструментального забезпечення демонстрації та наступного відпрацювання практичних навичок на кафедрі наявні спеціалізовані манекени та обладнання, які дозволяють у повному об’ємі виконувати всі маніпуляції, передбачені алгоритмами надання невідкладної медичної допомоги. Важливим аспектом, завдяки якому кафедра наслідує сучасним міжнародним стандартам надання допомоги, є розподіл викладання практичних навичок надання невідкладної допомоги з урахуванням загальноприйнятих в усьому світі понять BLS (basic life support) та ALS (advanced life support). Висновок. Оптимізація методики викладання практичних навичок для надання невідкладної медичної допомоги відповідно до сучасних стандартів лікування невідкладних станів збільшує якість надання допомоги та дозволяє зменшити втрати часу на догоспітальному етапі, що здатне значною мірою підвищити виживання та відсоток позитивного прогнозу для пацієнтів з невідкладною медичною патологією.

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