Advanced cardiac life support or Advanced Cardiovascular Life Support (ACLS) refers to a set of clinical interventions for the urgent treatment of cardiac arrest, stroke and other life threatening medical emergencies, as well as the knowledge and skills to deploy those interventions.[1]
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Extensive medical knowledge and rigorous hands-on training and practice are required to master ACLS. 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. Some health professionals, or even lay rescuers, may be trained in basic life support (BLS), especially cardiopulmonary resuscitation or CPR. 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.
It often starts with analysing 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 (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.
The ACLS guidelines were updated by the American Heart Association[2] and the International Liaison Committee on Resuscitation [3] in 2010. New ACLS guidelines focus on BLS as the core component of ACLS. Foci also include end tidal CO2 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. and a new change in arrangement of CPR steps to be CAB rather than ABC.
The 2005 guidelines acknowledged that high quality chest compressions and early defibrillation were the key to positive outcomes while other "typical ACLS therapies ... "have not been shown to increase rate of survival to hospital discharge".[4] In 2004 a study found that the basic interventions of CPR and early defibrillation and not the advanced support improved survival from cardiac arrest.[5]
The 2005 guidelines where published in Circulation.[6] The major source for ACLS courses and textbooks in the United States is the American Heart Association; in Europe, it 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.
Stroke is also included in the ACLS course with emphasis on the stroke chain of survival.
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.[7]
Notes on using the ACLS algorithm
The ACLS guidelines were first published in 1974 by the American Heart Association and were updated in 1980, 1986, 1992, 2000, 2005, and 2010.[10]
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