BLS Outperforms ALS for Out-of-Hospital Cardiac Arrest

Patients with out-of-hospital cardiac arrest are typically treated with advanced life support (ALS) rather than basic life support (BLS). However, there is little evidence of benefit for ALS, and the 2004 Ontario Prehospital Advanced Life Support (OPALS) study found no improvements in survival or neurological outcome after implementation of ALS protocols in 17 cities in Ontario (NEJM JW Emerg Med Sep 29 2004). Given the significant resources allocated to ALS training and response, these authors analyzed Medicare data to compare outcomes between patients with out-of-hospital cardiac arrest treated with ALS and those treated with BLS.

The analysis included 32,935 patients, of whom 5% were treated with BLS. Patients treated with ALS had lower r…