Advanced cardiac life support

Advanced cardiac life support, or advanced cardiovascular life support, often referred to by its acronym, "ACLS", refers to a set of clinical algorithms for the urgent treatment of cardiac arrest, stroke, myocardial infarction (also known as a heart attack), and other life-threatening cardiovascular emergencies. Outside North America, Advanced Life Support (ALS) is used.
Providers.
Only qualified health care providers can provide ACLS, as it requires the ability to manage the person's airway, initiate vascular access, read and interpret electrocardiograms, and understand emergency pharmacology. These providers include physicians, pharmacists, paramedics, advanced practice providers (physician assistants and nurse practitioners), respiratory therapists, and nurses. Other emergency responders may also be trained.
Some health professionals, or even lay rescuers, may be trained in basic life support (BLS), especially cardiopulmonary resuscitation (CPR), which makes up the core foundation of ACLS. 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 automated external defibrillators (AEDs).
Electrocardiogram interpretation.
ACLS often starts with analyzing the patient's heart rhythms with a manual defibrillator. In contrast to an AED in BLS, where the machine makes the determination as to when to defibrillate (shock) a patient, the ACLS team leader makes those decisions based on rhythms on the monitor and the patient's vital signs. The next steps in ACLS are insertion of intravenous (IV) lines and placement of various airway devices, such as an endotracheal tube (an advanced airway used in intubations). Commonly used ACLS drugs, such as epinephrine and amiodarone, are then administered. The ACLS personnel quickly search for possible reversible causes of cardiac arrest (i.e. the H's and T's, heart attack). 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.
The American Heart Association and the International Liaison Committee on Resuscitation perform a science review every five years and publish an updated set of recommendations and educational materials. These guidelines are often synonymously referred to as Emergency Cardiovascular Care (ECC) Guidelines. Following are recent changes.
2015 guidelines.
The 2015 ACLS guidelines promoted minor tweaks and improvements to the 2010 guidelines with no major changes. Some changes included:
2010 guidelines.
The ACLS guidelines were updated by the American Heart Association and the International Liaison Committee on Resuscitation in 2010. New ACLS guidelines focus on BLS as the core component of ACLS. Foci also include end tidal 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. CPR (for ACLS and BLS) was reordered from "ABC" to "CAB" (circulation, airway, breathing) to bring focus to chest compressions, even recommending compression-only CPR for laypersons. (note, however, that in pediatric resuscitation, respiratory arrest is more likely to be the main cause of arrest than adults.)
2005 guidelines.
The 2005 guidelines acknowledged that high quality chest compressions and early defibrillation are the key to positive outcomes, while other "typical ACLS therapies ... "have not been shown to increase rate of survival to hospital discharge". In 2004, a study found that the basic interventions of CPR and early defibrillation and not the advanced support improved survival from cardiac arrest.
The 2005 guidelines were published in "Circulation". 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.
History.
The ACLS guidelines were first published in 1974 by the American Heart Association and were updated in 1980, 1986, 1992, 2000, 2005, 2010, and most recently in 2015. Starting in 2015, updates are to be made on an ongoing basis. Nevertheless, the traditional major updates at five-year intervals will continue.