From the Guidelines
The latest Advanced Cardiovascular Life Support (ACLS) guidelines for cardiac arrest management emphasize high-quality CPR with minimal interruptions as the foundation of care, with chest compressions performed at a rate of 100-120 compressions per minute and a depth of 2-2.4 inches (5-6 cm) 1.
Key Recommendations
- Chest compressions should be performed at a rate of 100-120 compressions per minute with a depth of 2-2.4 inches (5-6 cm), allowing for complete chest recoil between compressions.
- Rescuers should minimize pauses in compressions, with a goal of less than 10 seconds for rhythm checks and other interventions.
- For medication administration, epinephrine 1 mg IV/IO should be given as soon as possible for non-shockable rhythms (asystole/PEA) and after the first unsuccessful shock for shockable rhythms (VF/pVT), then repeated every 3-5 minutes.
- Defibrillation for shockable rhythms should occur as quickly as possible using biphasic energy at 120-200 joules or manufacturer's recommendation.
- Advanced airway management should not delay other interventions, with either endotracheal intubation or supraglottic airway devices being acceptable.
- Post-cardiac arrest care includes targeted temperature management (33-36°C for at least 24 hours), hemodynamic optimization, and consideration of coronary angiography for suspected cardiac etiology.
Rationale
These guidelines prioritize the interventions that have been shown to improve survival outcomes, with high-quality CPR and early defibrillation for shockable rhythms having the greatest impact on survival 1. The guidelines also emphasize the importance of minimizing pauses in compressions and providing high-quality CPR with minimal interruptions 1. Additionally, the guidelines recommend the use of advanced airway devices and strategies during cardiac arrest, including bag-mask ventilation, supraglottic airway, or endotracheal intubation 1. The latest guidelines also discuss the lack of data in recent cardiac arrest literature that limits the ability to evaluate diversity, equity, and inclusion in this population 1. Overall, the guidelines aim to improve survival outcomes and reduce morbidity and mortality associated with cardiac arrest.
From the Research
Latest ACLS Guidelines for Cardiac Arrest Management
The latest Advanced Cardiovascular Life Support (ACLS) guidelines for cardiac arrest management emphasize the importance of prompt initiation of hands-only compression at a rate of at least 100 per min, to a depth of 2 in., with full chest recoil, and no more than a 10-s interruption of compressions 2.
Medications Used in Cardiac Arrest Management
Several medications have been evaluated for use in cardiac arrest, including:
- Epinephrine, which is a core component of guidelines and recommended at a dose of 1 mg in those with shockable rhythms if initial CPR and defibrillation are unsuccessful, while in nonshockable rhythms, guidelines recommend that epinephrine 1 mg be administered as soon as feasible 3.
- Antiarrhythmics, such as amiodarone and lidocaine, which may be used in those with cardiac arrest and refractory pulseless ventricular tachycardia (pVT)/ventricular fibrillation (VF) 3, 4, 5, 6.
- Vasopressin and steroids, which may be used in combination with epinephrine to improve return of spontaneous circulation (ROSC) among those with in-hospital cardiac arrest 3.
Key Findings
Key findings from recent studies include:
- Lidocaine was associated with statistically significantly higher odds of ROSC, 24-h survival, survival to hospital discharge, and favorable neurologic outcome compared to amiodarone in adult patients with in-hospital cardiac arrest from VT/VF 4.
- There was no significant difference in the rate of survival to hospital discharge between cardiogenic out-of-hospital cardiac arrest (OHCA) patients with persistent ventricular fibrillation on hospital arrival treated with amiodarone or lidocaine 5.
- The use of amiodarone and/or lidocaine in shockable patients presenting with out-of-hospital cardiac arrest was associated with improved 1-year survival rates compared to non-treatment 6.
Administration Routes and Dosing
Routes of administration for cardiac arrest medications may include intravenous (IV) and intraosseous (IO), with IV administration recommended as the first line, and IO access used if an attempt at IV access is unsuccessful 3. The dosing of these medications is critical, with epinephrine recommended at a dose of 1 mg, and antiarrhythmics such as amiodarone and lidocaine used according to specific guidelines and protocols 3, 4, 5, 6.