From the Guidelines
Advanced Cardiac Life Support (ACLS) is a set of clinical protocols for the urgent treatment of cardiac arrest, stroke, and other life-threatening cardiovascular emergencies, with the core components including high-quality CPR, early defibrillation, and medication administration, as outlined in the 2020 American Heart Association guidelines 1. The primary goal of ACLS is to restore cardiac function and improve survival rates, with a focus on high-quality CPR, which includes adequate compression depth and rate, as well as minimal interruptions in compressions.
- Key components of ACLS include:
- High-quality CPR with a rate of 100-120 compressions per minute and a depth of 2-2.4 inches, allowing for complete chest recoil
- Early defibrillation for shockable rhythms, such as ventricular fibrillation or pulseless ventricular tachycardia
- Establishment of vascular access for medication delivery
- Administration of epinephrine (1 mg IV/IO every 3-5 minutes) and amiodarone (300 mg IV/IO for the first dose, 150 mg for the second dose) or lidocaine (1-1.5 mg/kg IV/IO for the first dose, 0.5-0.75 mg/kg for subsequent doses) for persistent ventricular fibrillation or pulseless ventricular tachycardia
- ACLS algorithms guide treatment based on whether the rhythm is shockable (ventricular fibrillation/pulseless ventricular tachycardia) or non-shockable (asystole/pulseless electrical activity), as discussed in the 2018 American Heart Association focused update on advanced cardiovascular life support 1. The most recent guidelines emphasize the importance of team-based care, clear communication, and regular practice to ensure rapid, coordinated responses during emergencies, with a focus on optimizing oxygenation, ventilation, hemodynamic support, and targeted temperature management in post-resuscitation care 1. The 2020 guidelines also highlight the need for prompt initiation of targeted temperature management for all patients who do not follow commands after return of spontaneous circulation, as well as accurate neurological prognostication in brain-injured cardiac arrest survivors 1.
- Overall, ACLS is a critical component of emergency cardiovascular care, and its effectiveness relies on the integration of high-quality CPR, advanced interventions, and post-resuscitation care, as outlined in the most recent guidelines 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Overview of ACLS
- Advanced Cardiovascular Life Support (ACLS) is a set of clinical interventions for the urgent treatment of cardiac arrest and other life-threatening medical emergencies.
- The primary goal of ACLS is to restore cardiac function and prevent further deterioration of the patient's condition.
Medications Used in ACLS
- Epinephrine is a core component of ACLS guidelines, recommended at a dose of 1 mg for patients with shockable rhythms if initial CPR and defibrillation are unsuccessful, and as soon as feasible for those with nonshockable rhythms 2, 3.
- Antiarrhythmic medications such as amiodarone and lidocaine may be used in certain situations, but their effectiveness is uncertain and they should be used with caution 4, 5.
- Calcium and sodium bicarbonate should not be routinely administered in cardiac arrest, and beta-blockers may be considered in specific cases 2.
Cardiopulmonary Resuscitation (CPR)
- High-quality CPR is essential for improving survival rates and neurological outcomes in cardiac arrest patients 6.
- Compression-only CPR should be used by responders who are unable or unwilling to perform mouth-to-mouth ventilations.
- Early recognition and intervention, including defibrillation and subsequent care in a specialist center, are critical for improving outcomes.
Management of Cardiac Arrest
- The underlying cause of cardiac arrest should be identified and treated during CPR 6.
- Care after cardiac arrest includes controlled reoxygenation, therapeutic hypothermia for comatose survivors, percutaneous coronary intervention, circulatory support, and control of blood-glucose levels and seizures.
- Prognostication in comatose survivors of cardiac arrest requires a careful, multimodal approach using clinical and electrophysiological assessments after at least 72 hours 6.