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advanced cardiac life support (ACLS)

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

Related

'quick-look' paddle ACLS ABCDs ACLS algorithm for suspected stroke ACLS medications administerable via endotracheal tube asystole 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)

Useful

basic life support (BLS)

Specific

pediatric basic & advanced cardiopulmonary life support

General

cardiopulmonary resuscitation (CPR)

References

  1. Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 170
  2. 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: 20956224
  3. 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. PMID: 25465423 http://content.onlinejacc.org/article.aspx?articleID=2020181
  4. 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: 19934423
  5. Kudenchuk PJ et al. Amiodarone, lidocaine, or placebo in out-of-hospital cardiac arrest. N Engl J Med 2016 Apr 4; PMID: 27043165 - Joglar JA, Page RL. Out-of-hospital cardiac arrest - are drugs ever the answer? N Engl J Med 2016 Apr 4 PMID: 27042874
  6. 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 PMID: 27053638 Free full text 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 PMID: 27052620 Free full text http://www.bmj.com/content/353/bmj.i1653 - Couper K, Perkins GD Improving outcomes from in-hospital cardiac arrest BMJ 2016;353:i1858 PMID: 27052030 http://www.bmj.com/content/353/bmj.i1858
  7. 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: 33773825 https://www.resuscitationjournal.com/article/S0300-9572(21)00063-0/fulltext
  8. 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: 38108133 Free article https://www.ahajournals.org/doi/10.1161/CIR.0000000000001194