Advanced Cardiovascular Life Support (ACLS) Details

Advanced cardiac life support (ACLS) refers to a series of medical treatment actions performed for the urgent treatment of cardiac arrest, stroke and other life threatening medical emergencies, as well as the knowledge and training needed to carry out the actions and properly handle the situation. When a sudden cardiac arrest occurs, immediate CPR is a vital link in the chain of survival. Another important link is early defibrillation, which has improved greatly with the widespread availability of AEDs.

Algorithms

The current ACLS guidelines are set into several groups of ‘algorithms’ – a set of instructions that are followed to standardize treatment, and increase its effectiveness. These algorithms usually come in the form of a flowchart, incorporating ‘yes/no’ type decisions, making the algorithm easier to memorize.

Training

The major source for ACLS courses and textbooks in the United States is the American Heart Association and in Europe is the European Resuscitation Council (ERC). Most institutions expect their staff to recertify at least every two years. Many sites offer training in simulation labs with simulated code situations with a dummy. Other hospitals accept software-based courses for recertification. An ACLS Provider Manual reflecting the new Guidelines is now available.

Required skills

Only qualified health care providers can provide ACLS, as it requires the ability to manage the patient’s airway, initiate IV access, read and interpret electrocardiograms, and understand emergency pharmacology. Extensive medical knowledge and rigorous hands-on training and practice are required to master ACLS. Qualified personel include: physicians (DOs and MDs), pharmacists (PharmDs), dentists (DDS and DMDs), midlevel practitioners (PAs and NPs), nurses (RNs), and paramedics. Other emergency responders may also be trained. Some health professionals, or even lay rescuers, may be trained in basic life support(BLS), especially cardiopulmonary resuscitation or CPR.

Electrocardiogram interpretation

It often starts with analyzing patient’s heart rhythms with a manual defibrillator. In contrast to an AED in BLS, where the machine decides when and how to shock a patient, the ACLS team leader makes those decisions based on rhythms on the monitor and patient’s vital signs. The next steps in ACLS are insertion of intravenous (IV) lines and placement of various airway devices. Commonly used ACLS drugs, such as epinephrine and amiodarone, are then administered. The ACLS personnel quickly search for possible causes of cardiac arrest (i.e. the H’s and T’s, heart attack ). Based on their diagnosis, more specific treatments are given. These treatments may be medical such as IV injection of an antidote for drug overdose, or surgical such as insertion of a chest tube for those with tensionpneumothoraces or hemothoraces.

Guidelines

2010 ACLS Guidelines

In 2010 the American Heart Association and the International Liaison Committee on Resuscitation updated the ACLS guidelines. New ACLS guidelines focus on BLS as the core component of ACLS. Changes include the exclusion of Atropine administration for pulseless electrical activity (PEA) and asystole and a new change in arrangement of CPR steps to be CAB rather than ABC. Additionally, the changes include end tidal CO2 monitoring as a measure of CPR effectiveness, and as a measure of ROSC.

2005 ACLS Guidelines

As of 2005, stroke is also included in the ACLS course with emphasis on the stroke chain of survival.The 2005 guidelines acknowledged that high quality chest compressions and early defibrillation are the key to positive outcomes while other “typical ACLS therapies … “have not been shown to increase rate of survival to hospital discharge”. In 2004 a study found that the basic interventions of CPR and early defibrillation and not the advanced support improved survival from cardiac arrest.