Patient outcomes as a result of a member of the resuscitation team attending an ALS course (EIT): Systematic Review

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This CoSTR is a draft version prepared by ILCOR, with the purpose to allow the public to comment and is labeled “Draft for Public Comment". The comments will be considered by ILCOR. The next version will be labelled “draft" to comply with copyright rules of journals. The final COSTR will be published on this website once a summary article has been published in a scientific Journal and labeled as “final”.

Conflict of Interest Declaration

The ILCOR Scientific Advisory Committee process is guided by a rigorous ILCOR Conflict of Interest policy. The following Task Force members and other authors declared an intellectual conflict of interest and this was acknowledged and managed by the Task Force Chairs and Conflict of Interest committees: Dr Andy Lockey & Prof Janet Bray

CoSTR Citation

Lockey, A, Bray, J on behalf of the International Liaison Committee on Resuscitation EIT Task Force. Patient outcomes as a result of a member of the resuscitation team attending an ALS course Consensus on Science with Treatment Recommendations [Internet] Brussels, Belgium: International Liaison Committee on Resuscitation (ILCOR) EIT Task Force, 2019 December 28 Available from http://ilcor.org

Methodological Preamble

This ILCOR Task Force Review is an “adolopment” of an existing publication “Lockey A., Lin Y., Cheng A. Impact of adult advanced cardiac life support course participation on patient outcomes-A systematic review and meta-analysis. Resuscitation. 2018;129:48-54”.

This was a systematic review and meta-analysis of eight observational studies (Lowenstein 1986 512, Sanders 1994 56, Makker 1995 116, Camp 1997 529, Pottle 2000 45, Dane 2000 83, Moretti 2007 458, Sodhi 2011 209). The literature search has been repeated on 31 October 2019, and no additional studies have been identified making the published work contemporary.

The totality of this identified evidence was considered by the EIT Taskforce, and the bias assessment tables and evidence profile tables from that study were considered. An Evidence to Decision profile was completed and discussed at the EIT Taskforce video conference on 18 November 2019. These data and the resulting discussion were then used to formulate the Consensus on Science and Treatment Recommendations.

PICOST

PICOST

Description (with recommended text)

Population

Adult in-hospital patients who have a cardiac arrest

Intervention

Prior participation of one or more members of the resuscitation team in an accredited advanced life support course

Comparison

No such participation

Outcomes

ROSC, survival to hospital discharge or to 30 days, survival to one year

Study Design

  • Inclusion:
    • any language
    • specifically looking at A(C)LS
    • RCTs and observational
  • Exclusion:
    • other types of life support course (e.g. NLS, ATLS, BLS)
    • studies looking at impact of individual components (e.g. airway, drug therapy, defibrillation)

Timeframe

  • Publication in Resuscitation accepted 31 May 2018 – no date restriction on that review
  • Search strategy re-ran 29 July 2019 covering May 2018 onwards – no additional papers identified

Consensus on Science

For the critical outcome of “return of spontaneous circulation” we have identified very low quality evidence (downgraded for risk of bias, inconsistency, indirectness and imprecision) from six observational studies (Lowenstein 1986 512, Sanders 1994 56, Makker 1995 116, Pottle 2000 45, Moretti 2007 458, Sodhi 2011 209) enrolling 1461 patients showing benefit for advanced cardiac life support training (OR 1.64 95% CI 1.12 – 2.41).

For the critical outcome of “survival to hospital discharge” or “survival to 30 days” we have identified very low quality evidence (downgraded for risk of bias, inconsistency, indirectness and imprecision) from seven observational studies (Lowenstein 1986 512, Sanders 1994 56, Camp 1997 529, Pottle 2000 45, Dane 2000 83, Moretti 2007 458, Sodhi 2011 209) enrolling 1507 patients showing benefit for advanced cardiac life support training (OR 2.43 95% CI 1.04 – 5.70)

For the critical outcome of “survival to 1 year” we have identified very low quality evidence (downgraded for risk of bias, inconsistency, and imprecision) from two observational studies (Pottle 2000 45, Moretti 2007 458) enrolling 455 patients showing no benefit for advanced cardiac life support training (OR 3.61 95% CI 0.11 – 119.42).

Treatment Recommendations

We recommend the provision of accredited adult advanced cardiac life support training for health care professionals (weak recommendation, very low quality of evidence).

Justification and Evidence to Decision Framework Highlights

Adult advanced cardiac life support training improves resuscitation knowledge and skills and it is likely to ensure best practice is applied in these emergency situations.

We recognize that the evidence in support of this recommendation comes from observational studies of very low quality. However, pooling of the available evidence consistently favours advanced cardiac life support training, and having advanced cardiac life support trained staff present during an attempted adult resuscitation has been found to reduce treatment errors such as incorrect rhythm assessment (Makker 1995 116) and time to ROSC (Moretti 2007 458). We recognise that the provision of accredited adult advanced cardiac life support training may not be feasible or appropriate in low resource settings.

Values and preferences statement: In making this recommendation we recognize that the evidence in support of this recommendation comes from observational studies of very low quality and only relate to accredited adult advanced life support courses. We recognise that the provision of accredited adult advanced cardiac life support training may not be feasible in low resource settings.

Knowledge Gaps

Knowledge gaps: Impact on patient outcomes of prior participation of one or more members of the cardiac arrest team for other life support courses (e.g. paediatrics, newborns).

Attachments

Evidence-to-Decision Table: ALS Training

References

  • Camp BN, Parish DC, Andrews RH. Effect of advanced cardiac life support training on resuscitation efforts and survival in a rural hospital. Ann Emerg Med 1997;29(4):529–33.
  • Dane FC, Russell-Lindgren KS, Parish DC, Durham MD, Brown TD. In-hospital resuscitation: association between ACLS training and survival to discharge. Resuscitation 2000;47:83–7.
  • Lockey A., Lin Y., Cheng A. Impact of adult advanced cardiac life support course participation on patient outcomes-A systematic review and meta-analysis. Resuscitation. 2018;129:48-54Pottle A, Brant S. Does resuscitation training affect outcome from cardiac arrest? Accid Emerg Nurs 2000;8:45–51.
  • Lowenstein SR, Sabyan EM, Lassen CF, Kern DC. Benefits of training physicians in advanced cardiac life support. Chest 1986;89(4):512–6.
  • Makker R, Gray-Siracusa K, Evers M. Evaluation of advanced cardiac life support in a community teaching hospital by use of actual cardiac arrests. Heart Lung 1995;24:116–20.
  • Moretti MA, Cesar LAM, Nusbacher A, Kern KB, Timerman S, Ramires JAF. Advanced cardiac life support training improves long-term survival from in-hospital cardiac arrest. Resuscitation 2007;72:458–65.
  • Pottle A, Brant S. Does resuscitation training affect outcome from cardiac arrest? Accid Emerg Nurs 2000;8:45–51.
  • Sanders AB, Berg RA, Burress M, Genova RT, Kern K, Ewy GA. The efficacy of an ACLS training program for resuscitation from cardiac arrest in a rural community. Ann Emerg Med 1994;23(1):56–9.
  • Sodhi K, Singla MK, Shrivastava A. Impact of advanced cardiac life support training program on the outcome of cardiopulmonary resuscitation in a tertiary care hospital. Indian J Crit Care Med 2011;15(4):209–12.

Discussion

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