From the Guidelines
The Advanced Cardiovascular Life Support (ACLS) guidelines are a set of recommendations for the treatment of cardiac arrest and other cardiovascular emergencies, as outlined by the American Heart Association (AHA) 1.
Key Components of ACLS
- Basic Life Support (BLS): provides the foundation for ACLS, including cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use
- Advanced Cardiovascular Life Support: comprises the level of care between BLS and post–cardiac arrest care, and includes the use of medications, such as epinephrine and vasopressin, as well as advanced airway management and extracorporeal cardiopulmonary resuscitation (ECPR) 1
- Post-Cardiac Arrest Care: includes targeted temperature management, cardiorespiratory support, and percutaneous coronary intervention
Updates to ACLS Guidelines
The AHA has published several updates to the ACLS guidelines, including the 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care 1 and the 2019 American Heart Association Focused Update on Advanced Cardiovascular Life Support 1. These updates include revised recommendations for the use of advanced airways, vasopressors, and ECPR during cardiac arrest. The most recent update, the 2023 American Heart Association Focused Update on Adult Advanced Cardiovascular Life Support, provides further guidance on the use of medications, temperature management, and ECPR in cardiac arrest patients 1.
Medications and Interventions
- Epinephrine: recommended for use in cardiac arrest, with a dose of 1 mg intravenously every 3-5 minutes 1
- Vasopressin: removed from the pulseless arrest algorithm in the 2015 guidelines, but may still be considered for use in certain situations 1
- Advanced Airway Management: includes the use of bag-mask ventilation, supraglottic airway, or endotracheal intubation, with revised recommendations for the choice of advanced airway devices and strategies during cardiac arrest 1
- Extracorporeal Cardiopulmonary Resuscitation (ECPR): may be considered for use in cardiac arrest patients who are refractory to conventional CPR, with revised recommendations for the application of ECPR and its potential impact on cardiac arrest survival 1
From the Research
Overview of Advanced Cardiovascular Life Support (ACLS) Guidelines
The ACLS guidelines emphasize the importance of:
- Early recognition of cardiac arrest and call for help 2, 3
- Good-quality chest compressions 2, 3
- Early defibrillation when applicable 2, 3
- Early administration of drugs 2, 3
- Appropriate airway management ensuring normoventilation 2, 3
- Delivery of appropriate post-resuscitation care to enhance survival 2, 4
Key Components of ACLS
The guidelines stress the following key components:
- Recognition of early warning signs 3
- Activation of the emergency medical system (EMS) 3
- Basic CPR 3
- Early defibrillation 3
- Intubation 3
- Intravenous medication 3
- Advanced airway management and ventilation 4
- Circulatory support and the appropriate use of drugs in resuscitation 4
- Identification of reversible causes of cardiac arrest 2, 4
Training and Skill Use
Studies have investigated the use of ACLS skills in clinical practice, finding that:
- Cardiac arrest team members use ALS skills more often than first responders 5
- The ALS course is more appropriately targeted to members of a cardiac arrest team 5
- Quality of basic life support is essential throughout the resuscitation effort 6
- ACLS providers should optimize the outcome by the integrated strategy that consists of appropriate "drug therapy", qualified "advanced airway management", and accurate "physiologic monitoring" 6