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

Abstract

Importance: Most out-of-hospital cardiac arrests receiving Emergency Medical Services in the United States are treated by ambulance providers trained in Advanced Life Support (ALS), but supporting evidence for the use of ALS over Basic Life Support (BLS) is limited. Objective: To compare the effects of BLS and ALS on outcomes after out-of-hospital cardiac arrest. Design, Setting, and Patients: Observational cohort study of a nationally representative sample of traditional Medicare beneficiaries from non-rural counties who experienced out-of-hospital cardiac arrest during 2009-2011 and for whom either ALS or BLS ambulance services were billed to Medicare (31,292 ALS cases and 1,643 BLS cases). Propensity score methods were used to compare the effects of ALS and BLS on patient survival, neurological performance, and medical spending after cardiac arrest. Main Outcomes and Measures: Survival to hospital discharge, to 30 days, and to 90 days; neurological performance; and incremental spending per additional survivor to 1 year. Results: Survival to hospital discharge was greater among patients receiving BLS (13.1% vs 9.2% for ALS; 4.0 percentage point difference, 95% CI: 2.3 - 5.7) as was survival to 90 days (8.0% vs 5.4% for ALS; 2.6 percentage point difference, 95% CI: 1.2 - 4.0). BLS was associated with better neurological functioning among hospitalized patients (21.8% vs 44.8%; 23.0 percentage point difference, 95% CI: 18.6 - 27.4). Incremental spending per additional survivor to 1 year for BLS relative to ALS was $154,333. Conclusions and Relevance: Patients with out-of-hospital cardiac arrest who received BLS had higher survival at discharge and at 90 days compared to ALS, and were less likely to experience poor neurological functioning.