More Advanced Emergency Care May Be Worse for Cardiac Arrest Victims: Study

Good CPR, getting to hospital fast resulted in better outcomes than using sophisticated methods

Monday, November 24, 2014

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MONDAY, Nov. 24, 2014 (HealthDay News) -- Advanced life support given by paramedics to cardiac arrest victims may cost lives rather than save them, researchers report.

The best treatment might just be good CPR given by paramedics or emergency medical technicians and getting the patient to the hospital as fast as possible, the Harvard University researchers noted.

"We find survival is longer with basic life support than advanced life support, which calls into question the widespread assumption that advanced pre-hospital care improves outcomes in cardiac arrest compared with basic life support," said study author Prachi Sanghavi, a Ph.D. student in the Harvard Program in Health Policy.

Each year in the United States, about 380,000 people receive emergency medical services for cardiac arrest. This is when the heart stops beating altogether. Most victims -- 90 percent -- do not survive to hospital discharge. This new study finds that at 90 days, patients treated with basic life support were nearly 50 percent more likely to survive than patients given advanced life support.

Basic life support for cardiac arrest includes CPR, early defibrillation -- shocking the heart back into beating -- and basic airway management and rapid transport. Basic life support can be given by either paramedics or emergency medical technicians.

Advanced life support adds advanced airway management by placing a tube into the patient's throat -- intubation -- and giving drugs to stimulate the heart. Advanced life support can be given only in ambulances staffed with paramedics. Paramedic ambulances are common in cities and suburbs.

"It may seem counterintuitive that advanced care leads to worse outcomes," Sanghavi said. The results of the study, however, paint that picture.

More cardiac arrest patients treated with basic life support lived to leave the hospital than those treated with advanced life support (13 percent versus 9 percent). Also, more patients given basic life support were alive 90 days after the event than patients given advanced life support (8 percent versus 5 percent), the investigators found.

Moreover, patients treated with basic life support were less likely to have poor mental functioning than those treated with advanced life support (22 percent versus 45 percent), the findings showed.

Sanghavi said that these outcomes may be the result of delays in getting patients to the hospital caused by taking time to start intravenous drugs and intubation.

In addition to having better outcomes, basic life support costs less, according to Sanghavi.

For the study, Sanghavi and her colleagues used a large sample of Medicare claims for ambulance services in urban areas between 2009 and 2011.

Using these data, they compared survival among more than 31,000 patients who received advanced life support with more than 1,600 who received basic life support.

The report was published Nov. 24 in the journal JAMA Internal Medicine.

Dr. Michael Callaham, an emergency medicine specialist at the University of California, San Francisco, and author of an accompanying journal editorial, said these results are not surprising. Current practice is for paramedics not to waste time intubating patients or giving drugs, as these measures haven't been shown to improve outcomes.

"We know that high-quality CPR, basic airway management and rapid defibrillation matter," he said. "There are studies that show that advanced life support doesn't matter. You don't have better survival. So, you are just doing more things and it takes more time."

Dr. Paul Barbara, associate chief of emergency medical services at Staten Island University Hospital in New York, agreed.

"The best advanced life support is good basic life support," he said. "Things like devices and gadgets are not the goal. The goal is teamwork and high-quality CPR."

SOURCES: Prachi Sanghavi, Ph.D. student, Harvard Program in Health Policy, Harvard University, Boston; Paul Barbara, M.D., associate chief of emergency medical services, Staten Island University Hospital, New York; Michael Callaham, M.D., emergency medicine specialist, University of California, San Francisco; Nov. 24, 2014, JAMA Internal Medicine

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