Advanced cardiac life support: Difference between revisions
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'''Advanced cardiac life support''' or '''Advanced Cardiovascular Life Support''' ('''ACLS''') refers to a set of clinical interventions for the urgent treatment of [[cardiac arrest]], [[stroke]] and other life threatening medical emergencies, as well as the knowledge and skills to deploy those interventions.<ref name=ACLS_2003_1>{{cite book |title=ACLS: Principles and Practice |publisher=American Heart Association |location=Dallas |year=2003 |isbn=0-87493-341-2 |page=1 }}</ref> |
'''Advanced cardiac life support''' or '''Advanced Cardiovascular Life Support''' ('''ACLS''') refers to a set of clinical interventions for the urgent treatment of [[cardiac arrest]], [[stroke]] and other life threatening medical emergencies, as well as the knowledge and skills to deploy those interventions.<ref name=ACLS_2003_1>{{cite book |title=ACLS: Principles and Practice |publisher=American Heart Association |location=Dallas |year=2003 |isbn=0-87493-341-2 |page=1 }}</ref> |
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Revision as of 15:53, 15 December 2011
 | It has been suggested that this article be merged with Advanced life support. (Discuss) Proposed since December 2011. |
Advanced cardiac life support or Advanced Cardiovascular Life Support (ACLS) refers to a set of clinical interventions for the urgent treatment of cardiac arrest, stroke and other life threatening medical emergencies, as well as the knowledge and skills to deploy those interventions.[1]
Advanced skills
Extensive medical knowledge and rigorous hands-on training and practice are required to master ACLS. Only qualified health care providers (e.g. physicians, paramedics, nurses, respiratory therapists, clinical pharmacists, physician assistants, nurse practitioners, exercise physiologists and other specially trained health care providers) can provide ACLS, as it requires the ability to manage the patient's airway, initiate IV access, read and interpret electrocardiograms, and understand emergency pharmacology. Some health professionals, or even lay rescuers, may be trained in basic life support (BLS), especially cardiopulmonary resuscitation or CPR. When a sudden cardiac arrest occurs, immediate CPR is a vital link in the chain of survival. Another important link is early defibrillation, which has improved greatly with the widespread availability of AEDs.
Electrocardiogram interpretation
It often starts with analysing patient's heart rhythms with a manual defibrillator. In contrast to an AED in BLS, where the machine decides when and how to shock a patient, the ACLS team leader makes those decisions based on rhythms on the monitor and patient's vital signs. The next steps in ACLS are insertion of intravenous (IV) lines and placement of various airway devices. Commonly used ACLS drugs, such as epinephrine and amiodarone, are then administered. The ACLS personnel quickly search for possible causes of cardiac arrest (e.g., a heart attack, drug overdose, or trauma). Based on their diagnosis, more specific treatments are given. These treatments may be medical such as IV injection of an antidote for drug overdose, or surgical such as insertion of a chest tube for those with tension pneumothoraces or hemothoraces.
Guidelines
2010 guidelines
The ACLS guidelines were updated by the American Heart Association[2] and the International Liaison Committee on Resuscitation [3] in 2010. New ACLS guidelines focus on BLS as the core component of ACLS. Foci also include end tidal CO
2 monitoring as a measure of CPR effectiveness, and as a measure of ROSC. Other changes include the exclusion of Atropine administration for pulseless electrical activity (PEA) and asystole.
and a new change in arrangement of CPR steps to be CAB rather than ABC.
2005 guidelines
The 2005 guidelines acknowledged that high quality chest compressions and early defibrillation were the key to positive outcomes while other "typical ACLS therapies ... "have not been shown to increase rate of survival to hospital discharge".[4] In 2004 a study found that the basic interventions of CPR and early defibrillation and not the advanced support improved survival from cardiac arrest.[5]
The 2005 guidelines where published in Circulation.[6] The major source for ACLS courses and textbooks in the United States is the American Heart Association; in Europe, it is the European Resuscitation Council (ERC). Most institutions expect their staff to recertify at least every two years. Many sites offer training in simulation labs with simulated code situations with a dummy. Other hospitals accept software-based courses for recertification. An ACLS Provider Manual reflecting the new Guidelines is now available.
Stroke is also included in the ACLS course with emphasis on the stroke chain of survival.
Algorithms
The current ACLS guidelines are set into several groups of 'algorithms' - a set of instructions that are followed to standardize treatment, and increase its effectiveness. These algorithms usually come in the form of a flowchart, incorporating 'yes/no' type decisions, making the algorithm easier to memorize.[7]
Notes on using the ACLS algorithm
- Search for and correct potentially reversible causes of arrest, brady/tachycardia.
- Exercise caution before using epinephrine in arrests associated with cocaine or other sympathomimetic drugs. Epinephrine is not required until after the second DC shock in standard ACLS management as DC shock in itself releases significant quantities of epinephrine[8]
- Give atropine 1 mg dose (IV) for asystole or slow PEA (rate<60/min) (No longer recommended.[9])
- In PEA arrests associated with hyperkalemia, hypocalcemia. or Ca2+
channel blocking drug overdose, give 10mL 10% calcium chloride (IV) (6.8 mmol/L) - Consider amiodarone for ventricular fibrillation/pulseless ventricular tachycardia after 3 attempts at defibrillation, as there is evidence it improves response in refractory VF / VT.
- For torsades de pointes, refractory VF in patients with digoxin toxicity or hypomagnesemia, give IV magnesium sulfate 8 mmol (4mL of 50% solution)
History
The ACLS guidelines were first published in 1974 by the American Heart Association and were updated in 1980, 1986, 1992, 2000, 2005, and 2010.[10]
See also
References
- ^ ACLS: Principles and Practice. Dallas: American Heart Association. 2003. p. 1. ISBN 0-87493-341-2.
- ^ Field JM, Hazinski MF, Sayre MR; et al. (2010). "Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 122 (18 Suppl 3): S640–56. doi:10.1161/CIRCULATIONAHA.110.970889. PMID 20956217.
{{cite journal}}: Explicit use of et al. in:|author=(help); Unknown parameter|month=ignored (help)CS1 maint: multiple names: authors list (link) - ^ Hazinski MF, Nolan JP, Billi JE; et al. (2010). "Part 1: executive summary: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations". Circulation. 122 (16 Suppl 2): S250–75. doi:10.1161/CIRCULATIONAHA.110.970897. PMID 20956249.
{{cite journal}}: Explicit use of et al. in:|author=(help); Unknown parameter|month=ignored (help)CS1 maint: multiple names: authors list (link) - ^ 2005 American Heart Association Guidelines, p. IV-58 Part 7.2: Management of Cardiac Arrest
- ^ Stiell IG, Wells GA, Field B; et al. (2004). "Advanced cardiac life support in out-of-hospital cardiac arrest". N. Engl. J. Med. 351 (7): 647–56. doi:10.1056/NEJMoa040325. PMID 15306666.
{{cite journal}}: Explicit use of et al. in:|author=(help); Unknown parameter|month=ignored (help)CS1 maint: multiple names: authors list (link) - ^ 2005 American Heart Association Guidelines, p. IV-58
- ^ "Chicago ACLS Classes". ACLS Classes. Retrieved 2 April 2011.
- ^ Bode, F. "Differential effects of defibrillation on systemic and cardiac sympathetic activity".
- ^ Neumar RW, Otto CW, Link MS; et al. (2010). "Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 122 (18 Suppl 3): S729–67. doi:10.1161/CIRCULATIONAHA.110.970988. PMID 20956224.
{{cite journal}}: Explicit use of et al. in:|author=(help); Unknown parameter|month=ignored (help)CS1 maint: multiple names: authors list (link) - ^ Mutchner L (2007). "The ABCs of CPR—again". Am J Nurs. 107 (1): 60–9, quiz 69–70. PMID 17200636.
{{cite journal}}: Unknown parameter|month=ignored (help)
External links
- "2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science". Circulation. 122 (18 Suppl 3). November 2010.
- "2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 112 (24 Suppl): IV1–203. December 2005. doi:10.1161/CIRCULATIONAHA.105.166550. PMID 16314375.
- European 2005 guidelines from European Resuscitation Council
