Data_Sheet_1_Advanced Life Support vs. Basic Life Support for Patients With Trauma in Prehospital Settings: A Systematic Review and Meta-Analysis.PDF

Background: Advanced Life Support (ALS) is regarded to be associated with improved survival in pre-hospital trauma care when compared to Basic Life Support (BLS) irrespective of lack of evidence. The aim of this study is to ascertain ALS improves survival for trauma in prehospital settings when compared to BLS.
Methods: We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials for published controlled trials (CTs), and observational studies that were published until Aug 2017. The population of interest were adults (>18 years old) trauma patients who were transported by ground transportation and required resuscitation in prehospital settings. We compared outcomes between the ALS and BLS groups. The primary outcome was in-hospital mortality and secondary outcomes were neurological outcome and time spent on scene.
Results: We identified 2,502 studies from various databases and 10 studies were included in the analysis (two CTs, and eight observational studies). The outcomes were not statistically significant between the ALS and BLS groups (pooled OR 1.14; 95% CI 0.95 to 1.36 for mortality, pooled OR 1.12; 95% CI 0.88 to 1.42 for good neurological outcomes, pooled mean difference −0.96; 95% CI−6.64 to 4.72 for on-scene time) in CTs. In observational studies, ALS prolonged on-scene time and increased mortality (pooled OR 1.56; 95% CI: 1.31 to 1.86 for mortality, and pooled mean difference, 1.26; 95% CI: 0.07 to 2.45 for on-scene time).
Conclusions: In prehospital settings, the present study showed no advantages of ALS on the outcomes in patients with trauma compared to BLS.

背景：高级生命支持（Advanced Life Support, ALS）相较于基础生命支持（Basic Life Support, BLS），虽缺乏相关证据支持，但既往被认为可改善院前创伤救治的患者生存率。本研究旨在明确院前创伤救治场景中，ALS对比BLS是否可提升患者生存率。
方法：本研究检索了PubMed、EMBASE及Cochrane对照试验中心注册库中截至2017年8月发表的对照临床试验（Controlled Trials, CTs）与观察性研究。研究对象为年龄≥18岁、经陆路转运且需在院前环境接受复苏治疗的成年创伤患者。本研究对比了ALS组与BLS组的结局指标：主要结局为住院死亡率，次要结局为神经功能预后与现场停留时间。
结果：从各数据库中共初检出2502项研究，最终纳入10项研究进行分析（含2项对照临床试验与8项观察性研究）。在对照临床试验中，ALS组与BLS组的结局无统计学显著性差异（死亡率的合并比值比为1.14；95%置信区间[CI] 0.95~1.36；良好神经功能预后的合并比值比为1.12；95%CI 0.88~1.42；现场停留时间的合并均数差为-0.96；95%CI -6.64~4.72）。在观察性研究中，ALS会延长现场停留时间并升高患者死亡率（死亡率的合并比值比为1.56；95%CI 1.31~1.86；现场停留时间的合并均数差为1.26；95%CI 0.07~2.45）。
结论：本研究结果显示，在院前创伤救治场景中，相较BLS，ALS并未展现出更优的患者结局获益。