Advanced cardiac life support

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Advanced cardiac life support (ACLS) is a detailed medical protocol for the provision of lifesaving cardiac care in settings ranging from the pre-hospital environment to the hospital setting.

Extensive medical knowledge and rigorous hands-on training and practice are required to master ACLS. Only qualified health care providers (doctors, nurses, emergency medical responders) can provide ACLS. Lay persons, however, can master basic life support (BLS) techniques after a short course. In cardiac arrest, immediate BLS by a lay person before the arrival of ACLS personnel and equipment is perhaps the most important step in successful resuscitation. This is especially true now that the use of automated external defibrillators (AEDs) in out-of-hospital setting has become part of BLS.

ACLS is an extension of BLS. It often starts with analysing patient's heart rhythms with a professional defibrillator/pacemaker. In contrast to an AED in BLS, where the machine decides when and how to shock a patient, 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 atropine, are then administered. At this time, the ACLS personnel quickly search for possible causes of cardiac arrest (e.g., a heart attack, drug overdose, or trauma). 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. While the above mentioned ACLS steps are being carried out, it is crucial to continue chest compression with minimal interruptions. This point is emphasized repeately in the new ACLS guidelines (see below)

More information can be found in The Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care (ACLS) published in JAMA [1]. The full guidelines may be found in Circulation[2]. The major source for ACLS courses and textbooks in the United States is the American Heart Association; in Europe, it is the ERC (European Resuscitation Council). New version of ACLS guidelines were introduced in December 2005 [3]. New ACLS textbooks will be available in spring of 2006.