Advanced cardiac life support
Cardio-pulmonary resuscitation of an avalanche victim who was medically evacuated to Craig Joint Theater Hospital in February 2010
Specialty	Emergency medicine

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Advanced cardiac life support, or advanced cardiovascular life support, often referred to by its abbreviation as 'ACLS', refers to a set of clinical algorithms for the urgent treatment of cardiac arrest, stroke, myocardial infarction, and other life-threatening cardiovascular emergencies.^[1] Outside North America, Advanced Life Support (ALS) is used.

From Wikipedia, the free encyclopedia. Jump to navigation Jump to search. Advanced cardiac life support. Specialty, Emergency medicine. Advanced cardiac life support, or advanced cardiovascular life support, often referred to by its. Only qualified health care providers can provide ACLS, as it requires the ability to.
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Advanced Cardiovascular Life Support Provider Manual 16th Edition PDF download The ACLS Provider Manual provides information needed before, during and after the Advanced Cardiovascular Life Support (ACLS) Provider course. It is also used as a clinical reference.

3Guidelines
4Algorithms

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Providers[edit]

Only qualified health care providers can provide ACLS, as it requires the ability to manage the person's airway, initiate vascular access, read and interpret electrocardiograms, and understand emergency pharmacology; these include physicians, pharmacists, dentists, advanced practice providers (physician assistants and nurse practitioners), respiratory therapists, nurses, paramedics and advanced emergency medical technicians. 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 (CPR), which makes up the core foundation of ACLS.^[2] 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 automated external defibrillators (AEDs).

Electrocardiogram interpretation[edit]

ACLS often starts with analyzing the patient's heart rhythms with a manual defibrillator. In contrast to an AED in BLS, where the machine makes the determination as to when to defibrillate (shock) a patient, the ACLS team leader makes those decisions based on rhythms on the monitor and the patient's vital signs. The next steps in ACLS are insertion of intravenous (IV) lines and placement of various airway devices, such as an endotracheal tube (an advanced airway used in intubations). Commonly used ACLS drugs, such as epinephrine and amiodarone, are then administered.^[3] The ACLS personnel quickly search for possible reversible 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 tension pneumothoraces or hemothoraces.

Guidelines[edit]

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The American Heart Association and the International Liaison Committee on Resuscitation performs a science review every five years and publishes an updated set of recommendations and educational materials. These guidelines are often synonymously referred to as Emergency Cardiovascular Care (ECC) Guidelines. Following are recent changes.

2015 guidelines[edit]

The 2015 ACLS guidelines promoted minor tweaks and improvements to the 2010 guidelines with no major changes. Some changes included:

In conjunction with the BLS guidelines, the update promoted the use of mobile phones to activate the Emergency Response System as well as notify nearby rescuers.^[4]
It was recommended that emergency medical dispatchers receive better guidance on recognizing potential Cardiac Arrests and agonal breathing to promote more immediate CPR instructions.^[4]
Lay persons are further encouraged to perform continuous hands-only CPR at a minimum until EMS arrival.^[4]
An upper boundary for the number of chest compressions was added at 120 per minute, making the current recommendation 100-120 per minute. The 2010 guidelines only stated 100+ per minute.^[4]
An upper boundary on the depth of chest compressions was added at 2.4 inches, making the current recommendation 2-2.4 inches. The 2010 guidelines only stated at least 2 inches.^[4]
Added BLS and lay person administration of naloxone (IM or IN) for suspected opiate overdoses.^[4]
For simplicity, vasopressin was removed from the Cardiac Arrest Algorithm.^[4]
Waveform capnography was further emphasized and an ETCO₂ of less than 10 mmHg after 20 minutes of resuscitation was added as legitimate factor in the decision to terminate resuscitation.^[4]
Targeted temperature management was further refined with a new goal range 32-36 °C.^[5]
Routine atropine use in intubations is no longer recommended unless there is a high risk for bradycardia.^[5]
The OHCA and IHCA (Out of hospital cardiac arrest) and (In Hospital Cardiac arrest) Chain also has been added as different ones. Separate Chains of Survival have been recommended that identify the different pathways of care for patients who experience cardiac arrest in the hospital as distinct from out-of-hospital settings.^[4]

2010 guidelines[edit]

The ACLS guidelines were updated by the American Heart Association^[6] and the International Liaison Committee on Resuscitation^[7] in 2010. New ACLS guidelines focus on BLS as the core component of ACLS.^[2] Foci also include end tidal CO
₂ monitoring as a measure of CPR effectiveness, and as a measure of ROSC. Other changes include the exclusion of atropine administration for pulseless electrical activity (PEA) and asystole. CPR (for ACLS and BLS) was reordered from 'ABC' to 'CAB' (circulation, airway, breathing) to bring focus to chest compressions, even recommending compression-only CPR for laypersons. (note, however, that in pediatric resuscitation, respiratory arrest is more likely to be the main cause of arrest than adults.^[8])

2005 guidelines[edit]

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'.^[9] In 2004, a study found that the basic interventions of CPR and early defibrillation and not the advanced support improved survival from cardiac arrest.^[10]

The 2005 guidelines were published in Circulation.^[11] The major source for ACLS cou