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Comment & Response
January 2019

Prehospital Advanced Life Support for Out-of-Hospital Cardiac Arrest in Blunt Trauma Patients

Author Affiliations
  • 1School of Medicine, Imperial College London, London, United Kingdom
JAMA Surg. 2019;154(1):95-96. doi:10.1001/jamasurg.2018.4291

To the Editor We thank Fukuda et al1 for their study analyzing the association of prehospital advanced life support (ALS) with the outcomes of out-of-hospital cardiac arrest. The authors conclude that ALS by physicians resulted in a higher 30-day survival than ALS by emergency medical service (EMS) personnel and basic life support (BLS).

However, the implications of the study may be overstated. First, given the retrospective design of the study, there are multiple confounding factors that the authors have not accounted for. These mainly include patient demographic characteristics, like age and sex; modifiable predictors of survival outcomes, like body mass index; general health status as assessed by the American Society of Anesthesiologists index; and comorbidities present, as shown in Table 1.1 Importantly, the extent of blunt injury (assessed by the Injury Severity Score or Abbreviated Injury Scale score) and etiology of cardiac arrest were not evaluated. A major predictor of survival was time to response,2 which was statistically different between the various cohorts (Tables 1 and 3).1 When comparing between EMS and physicians, it is pertinent to match their expertise, since physicians, unlike EMS, may have differing experience and hence success in providing life support.3 Similarly, many patients who survive long enough to reach the hospital for ALS by physicians fare better because of other above-mentioned factors.

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