From the Guidelines
The 2023 AHA ACLS Guidelines introduce significant updates to resuscitation protocols, emphasizing earlier epinephrine administration, flexible airway management, and comprehensive post-arrest care to improve survival outcomes. The guidelines now recommend earlier epinephrine administration for non-shockable rhythms, with the first dose given within 3-5 minutes of cardiac arrest recognition 1. For shockable rhythms, epinephrine should be administered after the second defibrillation attempt if return of spontaneous circulation (ROSC) hasn't occurred. The guidelines also introduce double sequential defibrillation as a Class 2b recommendation for refractory ventricular fibrillation 1.
Key Updates
- Post-cardiac arrest care has been enhanced with recommendations for targeted temperature management between 32-36°C for at least 24 hours in comatose adult patients 1
- Airway management now allows for either bag-mask ventilation or advanced airway placement based on provider skill level, without prioritizing either approach
- The guidelines emphasize point-of-care ultrasound use during resuscitation when available and performed by trained providers
- There's a greater focus on team dynamics and high-quality CPR with minimal interruptions, maintaining a compression rate of 100-120 per minute and depth of 2-2.4 inches
These changes reflect evolving evidence supporting earlier medication administration, flexible airway approaches, and comprehensive post-arrest care to improve survival outcomes, as highlighted in the 2023 focused update to the American Heart Association (AHA) advanced cardiovascular life support (ACLS) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care 1.
From the Research
Key Differences in AHA ACLS Guidelines for 2023
- The American Heart Association (AHA) Advanced Cardiovascular Life Support (ACLS) guidelines for 2023 emphasize the importance of prompt and proper treatment for cardiac arrest, including the use of epinephrine, defibrillation, and cardiopulmonary resuscitation (CPR) 2, 3, 4.
- Studies have shown that delays in CPR, defibrillation, and epinephrine administration can decrease survival rates in in-hospital cardiac arrest 4.
- The guidelines also highlight the importance of adherence to the ACLS protocol, as deviations from the protocol have been associated with decreased rates of return of spontaneous circulation (ROSC) and survival to discharge 3.
- The use of amiodarone and lidocaine for the treatment of in-hospital cardiac arrest due to ventricular tachycardia or ventricular fibrillation (VT/VF) is supported by the guidelines, with lidocaine being associated with higher odds of ROSC, 24-hour survival, survival to discharge, and favorable neurologic outcome compared to amiodarone 5.
- The guidelines also discuss the potential benefits and risks of using extracorporeal cardiopulmonary resuscitation (ECPR) and thrombolysis for cardiac arrest due to pulmonary embolism, highlighting the need for rapid identification and treatment of the underlying cause of cardiac arrest 6.
Treatment of Cardiac Arrest
- Prompt initiation of CPR is crucial for survival, with delays in initiation associated with decreased survival rates 4.
- Defibrillation and epinephrine administration should be performed promptly, with delays associated with decreased survival rates 4.
- The use of amiodarone and lidocaine for VT/VF cardiac arrest is supported by the guidelines, with lidocaine being associated with better outcomes compared to amiodarone 5.
- ECPR and thrombolysis may be considered for cardiac arrest due to pulmonary embolism, but the benefits and risks must be carefully weighed 6.
Importance of Adherence to ACLS Protocol
- Adherence to the ACLS protocol is crucial for optimal outcomes, with deviations from the protocol associated with decreased rates of ROSC and survival to discharge 3.
- The guidelines emphasize the importance of prompt and proper treatment, including the use of epinephrine, defibrillation, and CPR 2, 3, 4.