Cardiac arrest: life support courses decrease death.

Clinical bottom line (level 1a)

  1. Patients who have had a cardiac arrest and are attended by health care providers who have had recent training, are less likely to suffer mortality or morbidity than those treated by medics without re-training (NNT = 38 at unknown) .
Jabbour et al: Annals of Emergency Medicine 1996; 28 (6): 690-698
Expires October 2003

The study

Systematic review of randomised or not randomised, but candidates were evaluated before course instruction, by means of a pretest, to assess the level of baseline knowledge of
  • Patients: trauma needing life support
  • Intervention: life support courses compared with pre-life support courses
  • Outcome: morbidity/mortality, course participants' retention of knowledge or skills, change in practice behaviour among providers as a result of taking a course


    • Articles found in English using MEDLINE and ERIC, 1975 to 1992 (search terms: not given )

    Selection criteria: population of interest included health care providers (medical doctors, registered nurses or lay persons), the intervention included any of the identified life support courses and outcomes included those mentioned above
    Appraisal criteria: detailed in text
    Articles excluded if: ?

    17 studies (3 examined mortality and morbidity; 9 evaluated retention of knowledge or skills; 6 described a change in practice behaviour; 1 study was included in the first and third groups)
    • A life support course was defined as any one of the following: basic cardiac life support, advanced cardiac life support, PALS, modified advanced paediatric life support, ATLS or the neonatal resuscitation program.

    The evidence

    Outcome Time to outcome CER OR
    (95% CI)    		 NNT
    (95% CI)
    mortality and morbidity unknown /
    (%)    		 0.28
    (0.22 to 0.37)     		38
    (35 to 44)

    Comments

    1. No net increase in scores was found in 5 of 8 studies of retention of knowledge and in 8 of 9 studies of skill retention.
    2. The 3 studies assessing mortality and morbidity were given validity scores that corresponded to being of intermediate standard; the 6 assessing provider behaviour were all methodologically weak- nonrandom, nonblind assignment of patients, nonstandardised outcomes and poor follow-up were included in this group (and so were not analysed).

    Citation

    1. Jabbour M, Osmond MH, Klassen TP: Life support courses: Are they effective?. Annals of Emergency Medicine 1996; 28 (6): 690-698
    Contributor: Clare Wotton and Musab Hayatli, October 1999
    Reviewer: Roy Poses

    Clinical Question.
    Patient cardiac arrest
    Intervention or Exposure life support courses
    Comparison no life support courses
    Outcome morbidity/mortality