Does Pre-Hospital Advanced Life Support Improve Survival in Out-of-Hospital Cardiac Arrest? Interview with:
Alexis Cournoyer MD
Université de Montréal
Hôpital du Sacré-Cœur de Montréal
Institut de Cardiologie de Montréal,
Montréal, Québec, Canada. What is the background for this study? What are the main findings?

Response: Out-of-hospital advanced cardiac life support (ACLS) is frequently provided to patients suffering from cardiac arrest.  This was shown to improve rates of return of spontaneous circulation, but there was no good evidence that it improved any patient-oriented outcomes.  Given the progress of post-resuscitation care, it was important to reassess if ACLS improved survival in out-of-hospital cardiac arrest.  Also, with the advent of extracorporeal resuscitation, a promising technique that needs to be performed relatively early in the course of the resuscitation and which seems to improve patients’ outcome, we wanted to evaluate if prolonged prehospital resuscitation with ACLS was effective in extracorporeal resuscitation candidates.

In this study, we observed, as was noted in previous study, that prehospital advanced cardiac life support  did not provide a benefit to patients regarding survival to discharge, but increased the rate of prehospital return of spontaneous circulation.  It also prolonged the delay before hospital arrival of around 15 minutes.  In the patients eligible for extracorporeal resuscitation, we observed the same findings. What should clinicians and patients take away from your report?

Response: To improve survival following out-of-hospital cardiac arrest, efforts should be concentrated on increasing the rate of bystander-initiated cardiopulmonary resuscitation and lowering the delay before the first defibrillation.  Increasing the amount of advanced cardiac life support provider should not be a priority.  Also, in patients eligible for extracorporeal resuscitation, it might be reasonable to shorten their prehospital resuscitation phase to transport them to a facility where this therapy can be performed rapidly. What recommendations do you have for future research as a result of this study?

Response: As mentionned previously, we would like to evaluate the benefit of a rapid hospital redirection for potential extracorporeal resuscitation candidates as compared to the usual care of on-site ACLS and then transport. 

Disclosures: I do not have any disclosures.

Dr Denault is part of a speakers bureau for Medtronic, Masimo, Edwards and CAE Healthcare. Thank you for your contribution to the community.


Acad Emerg Med. 2017 Sep;24(9):1100-1109. doi: 10.1111/acem.13246. Epub 2017 Aug 16.

Prehospital Advanced Cardiac Life Support for Out-of-hospital Cardiac Arrest: A Cohort Study.

Cournoyer A1,2,3, Notebaert É1,2, Iseppon M1,2, Cossette S2, Londei-Leduc L1,4,5, Lamarche Y1,2,3, Morris J1,2, Piette É1,2, Daoust R1,2, Chauny JM1,2, Sokoloff C1,5, Cavayas YA1,2, Paquet J2, Denault A1,3,5.

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.






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