Abstract 417: Advanced vs. Basic Life Support Outcome Variation in the Treatment of Out-of-Hospital-Cardiac-Arrest in Detroit

Abstract

Background: Out-of-Hospital-Cardiac-Arrest (OHCA) may be treated with Advanced Life Support (ALS) and Basic Life Support (BLS). Previous literature has indicated that ALS provides no additional benefit to OHCA patients. This study compared OHCA outcomes between prehospital ALS or BLS care in a city with a preponderance of BLS only care. Study Objectives: To test for associations between prehospital ALS or BLS care stratified by initial cardiac rhythm on ROSC, discharged alive from the hospital, and on favorable neurological outcome at hospital discharge in OHCA of a presumed cardiac origin. Methods: A retrospective cohort of 6746 patients with non-traumatic OHCA who received CPR from a transporting EMS agency was collected using the Cardiac Arrest Registry to Enhance Survival (CARES) database. Patients were sorted into 4 cohorts based on ALS vs BLS care and initial shockable vs non-shockable cardiac rhythms. Cohorts were compared utilizing chi-squared and multivariable logistic regression analysis against the outcome variables of sustained ROSC, discharged alive from the hospital, and a favorable neurological outcome at hospital discharge. Results: After controlling for covariates, the odds of sustained ROSC were statistically significantly higher for S-ALS vs. NS-BLS (OR=4.4, p.001), S-BLS vs. NS-BLS (OR=1.8, p.001), and NS-ALS vs. NS-BLS (OR=2.2, p.001). The association between cohort and discharged alive from the hospital was also statistically significant (p.001), and discharged alive rates were S-ALS (17.9%); S-BLS (11.8%); NS-ALS (3.7%); NS-BLS (4.0%). The association between cohort and favorable neurological outcome was also statistically significant (p.001), and outcome rates were S-ALS (74.6%); S-BLS (58.2%); NS-ALS (36.5%); NS-BLS (41.6%). The odds of favorable neurological outcome were higher for S-ALS vs. NS-BLS (OR=2.6, p.001). Conclusion: In contrast to previous literature, ALS care in the study was superior to BLS care. ALS care was associated with higher rates of ROSC in OHCA patients regardless of rhythm. Further, ALS care was associated with higher rates of being discharged alive from the hospital and favorable neurological outcomes among patients with a shockable rhythm.