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.
Identify all potential conflicts of interest that might be relevant to your comment.
Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.
Err on the side of full disclosure.
If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.
Not all submitted comments are published. Please see our commenting policy for details.
Khanna VA, Chidambaram S, Goh EL. Prehospital Advanced Life Support for Out-of-Hospital Cardiac Arrest in Blunt Trauma Patients. JAMA Surg. 2019;154(1):95–96. doi:10.1001/jamasurg.2018.4291
Coronavirus Resource Center
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: