Mini-reviewAdvanced life support versus basic life support in the pre-hospital setting: A meta-analysis☆
Section snippets
Background
The impetus for the development of modern pre-hospital emergency medicine has come from a variety of concerns. Among the major forces has been the realization that traumatic injuries have often been neglected and that modern management of their care has been much better for wartime combatants than for civilians. Second, has been the recognition that cardiac arrest is capable of resuscitation, and need not be an automatic death sentence. Third has been the development of the specialty of
Materials & methods
The present review is based on a protocol which was peer reviewed by the Scientific Committee of the post-graduate program of Health Crisis Management of the University of Athens Medical School.
Study characteristics
Detailed results of the literature research are presented in Fig. 1. We initially identified 1081 potentially eligible citations by searching Medline (through PubMed, n = 276), EMBASE (n = 66), Cochrane Library (n = 376) and Scopus (n = 363). Two authors screened titles and abstracts for potential eligibility and 968 articles were excluded (689 articles were duplicated in the 4 different databases, 212 articles reported results of non comparative studies, 53 articles had other endpoints than survival
Discussion
In this systematic review, we have summarized the available evidence from controlled trials that compared ALS to BLS care in trauma and not trauma (cardiac arrest) patient survival to the pre-hospital setting. Information on the methodological quality was incomplete in a number of small-sized trials. In our study, trials that adequately reported methodological quality items were large trials, and dominate the pooled estimates of effect. Therefore, it is unlikely that pooled estimates are
Conclusions
Implementation of ALS care to non-traumatic cardiac arrest patients can increase survival and further research is unlikely to change our confidence in the estimate of the effect. On the contrary, in regards trauma patients, our meta-analysis and review produced non-significant results. There is necessity for further research which should concentrate on the evaluation of trauma systems, taking into consideration, the type of the trauma, the trauma severity as well as the pre-hospital setting
Limitations
There are a number of limitations in the study. Only few controlled studies of sufficient quality and strength examining survival in trauma were published and the majority of the data produced from controlled before-and-after trials and other controlled trials, which were not truly randomized but the treatment allocations were made using other pseudo- or quasi-random processes. Differences in patient (both cardiac arrest and trauma) between ALS versus BLS populations may have confounded the
Conflict of interest statement
No conflicts of interest to declare.
References (39)
Prehospital advanced life support vs “scoop and run” in trauma management
Ann Emerg Med
(1987)- et al.
A cumulative meta-analysis of the effectiveness of defibrillator-capable emergency medical services for victims of out-of-hospital cardiac arrest materials and methods
Ann Emerg Med
(1999) - et al.
Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses?
Lancet
(1998) - et al.
Meta-analysis in clinical trials
Control Clin Trials
(1986) - et al.
Level of prehospital care and risk of mortality in patients with and without severe blunt head injury
Injury
(2003) - et al.
A controlled trial of prehospital advanced life support in trauma
Ann Emerg Med
(1988) - et al.
Out-of hospital advanced life support with or without a physician: effects on quality of CPR and outcome
Resuscitation
(2009) - et al.
Comparison of two emergency response systems and their effect on survival from out of hospital cardiac arrest
Resuscitation
(1997) - et al.
Out-of-hospital resuscitation in Tartu: effect of reorganization of Estonian EMS system
Am J Emerg Med
(2000) - et al.
Prehospital Trauma Care
(2005)
Mobile intensive-care unit in the management of myocardial infarction
Lancet
The efficacy of advanced life support: a review of the literature
Prehosp Disaster Med
Advanced or basic life support for trauma: meta-analysis and critical review of the literature
J Trauma
Does advanced life support provides benefits to patients? A literature review
Prehosp Disaster Med
A systematic review of controlled studies: do physicians increase survival with prehospital treatment?
Scand J Trauma Resusc Emerg Med
Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials
JAMA
Reported methodological quality and discrepancies between small and large randomized trials in meta-analyses
Ann Intern Med
Empirical evidence of bias in treatment effect estimates in controlled trials with different interventions and outcomes: metaepidemiological study
BMJ (Clin Res Ed)
Cited by (0)
- ☆
A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2011.04.006.