advanced cardiac life support (ACLS)
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Introduction
Basic life support is the foundation of ACLS.
For ACLS protocols, identify the presenting cardiac rhythm to select appropriate protocol.
Also see pediatric basic & advanced cardiopulmonary life support
Management
ACLS protocols may be found in:
- flatline protocol
- pulseless electrical activity* (PEA)
- bradycardia
- asystole*
- tachycardia
- ventricular fibrillation
- ACLS algorithm for suspected stroke
* nonshockable rhythm
ACLS medications not helpful in out-of-hospital cardiac arrest[4]; amiodarone & lidocaine not effective[5]
patients who received epinephrine were less likely to survive with a good neurologic outcome than those who did not (17% vs 60%)[3][6]; however, these patients were older, had a longer resuscitation, were less likely to have had a witnessed event, & were less likely to have had a shockable rhythm[3]
European Resuscitation Council[7]
- epinephrine 1 mg without delay for patients in cardiac arrest with] non-shockable rhythm
- for shockable rhythm, epinephrine 1 mg after 3 defibrillation attempts
- amiodarone 300 mg for ventricular fibrillation or pulseless ventricular tachycardia after 3 defibrillation attempts
- consider additional amiodarone 150 mg after 5 defibrillation attempts
Notes
Related ACLS info:
- electrocardiogram
- artificial airway
- endotracheal intubation
- defibrillation
- initial management of acute coronary syndrome
- ACLS medications administerable via endotracheal tube
More general terms
More specific terms
Additional terms
- 'quick-look' paddle
- ACLS ABCDs
- ACLS algorithm for suspected stroke
- ACLS medications administerable via endotracheal tube
- asystole
- basic life support (BLS)
- bradyarrhythmia (bradycardia)
- combitube
- flatline protocol
- hypothermia
- initial management of acute coronary syndrome
- laryngeal mask airway (LMA)
- protocol for manual defibrillators
- pulseless electrical activity; electromechanical dissociation (PEA)
- tachyarrhythmia (tachycardia)
- termination of cardiopulmonary resuscitation (CPR)
- ventricular fibrillation (V Fib)
References
- ↑ Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 170
- ↑ Neumar RW, Otto CW, Link MS et al Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010 Nov 2;122(18 Suppl 3):S729-67 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20956224
- ↑ 3.0 3.1 3.2 Dumas F et al Is Epinephrine During Cardiac Arrest Associated With Worse Outcomes in Resuscitated Patients? J Am Coll Cardiol. 2014;64(22):2360-2367. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25465423 <Internet> http://content.onlinejacc.org/article.aspx?articleID=2020181
- ↑ 4.0 4.1 The NNT: Advanced Cardiac Life Support Medications for Cardiac Arrest. http://www.thennt.com/nnt/acls-medications-for-cardiac-arrest/
Olasveengen TM, Sunde K, Brunborg C, Thowsen J, Steen PA, Wik L. Intravenous drug administration during out-of-hospital cardiac arrest: a randomized trial. JAMA. 2009 Nov 25;302(20):2222-9 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19934423 - ↑ 5.0 5.1 Kudenchuk PJ et al. Amiodarone, lidocaine, or placebo in out-of-hospital cardiac arrest. N Engl J Med 2016 Apr 4; PMID: https://www.ncbi.nlm.nih.gov/pubmed/27043165
Joglar JA, Page RL. Out-of-hospital cardiac arrest - are drugs ever the answer? N Engl J Med 2016 Apr 4 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27042874 - ↑ 6.0 6.1 Andersen LW et al Early administration of epinephrine (adrenaline) in patients with cardiac arrest with initial shockable rhythm in hospital: propensity score matched analysis. BMJ 2016;353:i1577 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27053638 Free full text <Internet> http://www.bmj.com/content/353/bmj.i1577
Bradley SM et al Defibrillation time intervals and outcomes of cardiac arrest in hospital: retrospective cohort study from Get With The Guidelines-Resuscitation registry. BMJ 2016;353:i1653 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27052620 Free full text <Internet> http://www.bmj.com/content/353/bmj.i1653
Couper K, Perkins GD Improving outcomes from in-hospital cardiac arrest BMJ 2016;353:i1858 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27052030 <Internet> http://www.bmj.com/content/353/bmj.i1858 - ↑ 7.0 7.1 European Resuscitation Council Advanced Life Support Clinical Practice Guidelines (ESC, 2021). Medscape. June 2, 2021 https://reference.medscape.com/viewarticle/952264
Soar J, Bottiger BW, Carli P et al European Resuscitation Council Guidelines 2021: Adult advanced life support, Resuscitation. 2021 March 24 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33773825 https://www.resuscitationjournal.com/article/S0300-9572(21)00063-0/fulltext - ↑ Perman SM et al. 2023 American Heart Association focused update on adult advanced cardiovascular life support: An update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2024 Jan 30; 149:e254. PMID: https://www.ncbi.nlm.nih.gov/pubmed/38108133 Free article https://www.ahajournals.org/doi/10.1161/CIR.0000000000001194