AHA ACLS UPDATE ADVANCED CARDIAC LIFE SUPPORT

CARDIAC ARREST ALGORITHM

4 STEPS OF THE BLS SURVEY:
1. Check responsiveness
a. Tap and shout, “Are you alright?”
b. Scan the chest for movement
2. Activate the emergency response system
and get an AED
3. Check the carotid pulse; DO NOT spend >
10 sec checking for pulse!
a. If with pulse – support with rescue
breathing (1 every 5-6 sec)
b. If no pulse within 10 seconds – begin
CPR (30 compressions: 2 ventilations)
4. Defibrillation
a. Connect AED and deliver a shock if
indicated
b. One shock protocol for VF and
pulseless VT

HIGH QUALITY CPR

PUSH HARD, PUSH FAST!
- Rate of at least 100 chest compressions
per minute – PUSH FAST!
- Compression depth of at least 2 inches
(adult) – PUSH HARD!
- Allow chest recoil after each compression
- Switch rescuers every 2 min – prevent
fatigue
- Minimize interruptions in compressions MEDICATIONS:
- Avoid excessive ventilations 1. Administer vasopressors every 3-5 min
o Effects: 2. Vasopressin can replace the 1st or 2nd
 Gastric inflation dose of epinephrine
 Increased intra-thoracic 3. Administer amiodarone for refractory VF
pressure and VT
 Decreased venous return 4. Atropine no longer recommended for use
 Lower cardiac output in PEA or asystole
o For arrest patients: 5. Tachycardia – may use adenosine
 Tidal volume – 500-600 ml 6. Bradycardia – IV infusion of chronotropic
 Half a bag squeeze or agents when atropine is ineffective
enough to see the chest
rise SYNCHRONIZED CARDIOVERSION
Unstable Atrial Fibrillation:
WAVEFORM CAPNOGRAPHY - Initial biphasic dose – 120-200 J
- Less than 10 mmHg will not achieve Unstable Monomorphic VT
ROSC - Initial dose – 100 J
- Intra-arterial relaxation pressure < 20
mmHg – ineffective compressions
POST CARDIAC ARREST ALGORITHM - Should not be confused with normal
Goals: breathing
1. To provide guidance for prehospital
personnel in transporting the out-of-hospital Reference:
patient to an appropriate facility with post-
cardiac arrest care AHA 2010 Guidelines
2. To provide guidance to hospital personnel
for transporting the patient to a critical care
unit capable of providing post-cardiac arrest
care
3. To identify and treat the causes of the arrest
and prevent a recurrence
4. To optimize cardiopulmonary function and
vital organ perfusion – especially to the
brain and heart

Other Objectives:
1. Considering therapeutic hypothermia to
optimize survival and neurologic recovery
2. Identifying and treating acute coronary
syndromes
3. Reducing the risk of multiple-organ injury
4. Gathering data to assess recovery
5. Offering rehabilitation services to survivors if
needed

Key Interventions:
1. Induction of therapeutic hypothermia
2. Monitoring with quantitative waveform
capnography
3. Acquisition of a 12-lead ECG
4. Monitoring of O2 sat values
5. BP optimization
6. Determination of blood chemistry values

AIRWAY MANAGEMENT
1. Waveform capnography
- monitors the amount of carbon dioxide
exhaled by the patient
- Most reliable indicator of ET tube position
- Effectiveness of chest compressions
- ROSC
- Adequate coronary perfusion
2. Cricoid Pressure
- DO NOT routinely use to prevent
aspiration
3. Agonal gasps
- NOT EFFECTIVE BREATHS