Paramedic PapersHome Cardiac arrest Physician-directed ALS: no survival gain
Cardiac arrest
Physician-directed ALS: no survival gain
Regional implementation of a prehospital advanced life support program with video-assisted physician direction and outcomes after out-of-hospital cardiac arrest
Resuscitation · 2026-10 · Added 22 October 2026
A 129,207-case Korean difference-in-differences study found regions adopting video physician-directed prehospital ALS for cardiac arrest had modestly higher prehospital ROSC (+1.35 percentage points) but no gain in survival or neurological outcome, with prehospital times stretching about 4 minutes.
- Study type
- Cohort
- Design
- Retrospective difference-in-differences cohort
- Participants
- 129,207 adults with OHCA across South Korea
- Main finding
- SALS regions gained prehospital ROSC (+1.35 pp, 95% CI 0.56–2.15) but not survival to discharge (−0.35 pp) or favourable neurological outcome, while prehospital time rose 4.12 minutes
- Caveat
- Event-study analysis suggested differential pre-intervention trends, weakening the time-interval finding
- Bottom line
- Context only
Why it matters in Australia (Medium relevance). Real-time physician direction of paramedic ALS is not the Australian crew model, but the finding feeds the broader question of how much on-scene advanced care buys in cardiac arrest.
Learning goal
Weigh the benefits and system costs of physician-directed prehospital advanced life support in out-of-hospital cardiac arrest.
More
- Topic: Cardiac arrest
- Daily scan: 22 October 2026
Related papers on Cardiac arrest
-
Shorter pulse checks linked to more ROSC
A 252-patient quasi-randomised multicentre study in Türkiye found pulse checks completed within 5 seconds were associated with roughly double the ROSC rate of checks lasting 6–10 seconds (36.3% vs 19.5%, OR 2.39), alongside better capnographic dynamics.
-
Fatigue common a year after cardiac arrest
A Victorian population-based cohort of 728 out-of-hospital cardiac arrest survivors found fatigue in 35.8%, anxiety in 22.6% and depression in 18.0% at 12 months, with heavier symptom burden linked to worse quality of life, function and return to work.
-
Pad application is the AED time bottleneck
Timestamps from 8,115 remotely monitored Japanese AEDs showed pad application consumed a median 81% of the power-on-to-first-analysis interval, with completion inside about 50 seconds marking shocks delivered within 60 seconds of power-on.
-
Dispatcher training + volunteer app: more CPR, no outcome gain
A stepped-wedge cluster-randomised trial in French EMS agencies found dispatcher training in arrest recognition, telephone CPR and a geolocated volunteer responder app was associated with more bystander CPR (61.4% to 70.9%, adjusted OR 1.54), an effect that lost significance after adjusting for secular trends; clinical outcomes did not improve.