The document outlines the updated American Heart Association guidelines for adult Advanced Cardiovascular Life Support (ACLS), emphasizing the importance of rapid intervention in cardiac arrest situations, including the roles of trained responders and the use of advanced medical techniques. It highlights the significance of bystander CPR and tools such as defibrillators, while discussing protocols for drug administration and post-arrest care. Additionally, the document stresses ongoing education, training methodologies, and the necessity of a structured system for improving outcomes in cardiac arrest cases.

1. ADULT
ACLS –AHA HIGHLIGHTS
BY
DR. RAVIKIRAN H M
MBBS, DNB ANAESTHESIOLOGY
ADMO, CENTRAL HOSPITAL, MALIGAON

2. Advanced cardiovascular life support-ACLS", refers to a set of clinical guidelines for
the urgent and emergent treatment of life-threatening cardiovascular conditions that
will cause or have caused cardiac arrest, using advanced medical procedures,
medications, and techniques.
INTRODUCTION

3.  This has been re-emphasized. Risk of harm to the patient is
low if the patient is not in cardiac arrest.
 Less than 40% of adults receive layperson-initiated CPR, and
fewer than 12% have an AED applied before EMS arrival.
 Within 10sec of cardiac arrest patient loose consciousness
 Brain survival time: 4min
 Every 1minute delay in defibrillation reduce chance of
survival by 10%
 Bystander CPR doubles the rate of survival
EARLY INITIATION OF CPR BY LAY RESCUERS: GOLDEN
MINUTES

4. BLS ACLS
CAN BE PERFORMED BY ANYONE TRAINED MEDICAL PARAMEDICAL
STAFF
RHYTHM IDENTIFICATION BY AED RHYTHM IDENTIFICATION BY
RESUSICATOR
AED FOR DEFIBRILLATION MANUAL DEFIBRILLATOR
NO IV LINE DRUG USE IV LINE AND DRUG MANAGEMENT
NO ADVANCED AIRWAY ADVANCED AIRWAY USE
NO OXYGEN SUPPORT OXYGEN SUPPORT

5. Comprises of Doctors, trained paramedical staff, Nurses.
MEMBERS: Minimum 6 and maximum 10
1. 1 TEAM LEADER
2. 1 COMPRESSOR & 1 VENTILATOR ( CHANGE
ROLES EVERY 2 MINS)
3. 1 DEFIBRILLATOR
4. 1 INTRAVENOUS DRUG DELIVERY
5. 1 TIME KEEPER
Note: CPR coach to help team leader. CPR coach ensures
high quality BLS, while team leader focuses on other
aspects like ACLS
TEAM OF TRAINED PROFESSIONALS
The Compressor
AED/Monitor/
Defibrillator
The Airway
Manager
Resuscitation
Triangle Roles
around
patient
The Leadership Roles are:
1.Team Leader
2.IV/IO/Medication Administrator
3.Timekeeper/Recorder

7. CHAINS OF SURVIVAL

8. RECOGNITION OF CARDIAC ARREST

18. NONVASOPRESSOR MEDICATIONS
DURING CARDIAC ARREST

22. OPENING AIRWAY

26. ADVANCED AIRWAY DEVICE

31. CPR FEEDBACK DEVICES

38. PRECORDIAL THUMP

39. COUGH CPR

40. ELECTRIC PACING

41. IV vs IO DURING CPR
• Can be kept up-to 48hrs
• If trained well <10sec procedure
• Also useful for burr hole

43. MECHANICAL CPR DEVICES

44. IMPEDENCE TRESHOLD DEVICES
(a) Impedance threshold device (ITD) and ResQCPR:
ResQPod+ResQPump. (b) Phased thoracic-abdominal compression-
decompression CPR

45. INTERPOSED ABDOMINAL COMPRESSION CPR

46. ECPR
Use of extracorporeal cardiopulmonary resuscitation for patients with cardiac arrest
refractory to standard advanced cardiovascular life support is reasonable in select patients
when provided within an appropriately trained and equipped system of care.

47.  With respect to timing, for cardiac arrest with a nonshockable rhythm, it is reasonable to
administer epinephrine as soon as feasible.
 With respect to timing, for cardiac arrest with a shockable rhythm, it may be reasonable to
administer epinephrine after initial defibrillation attempts have failed.
 Reasonable to use audiovisual feedback devices during CPR for real-time optimization of
CPR performance
 Reasonable to use physiologic parameters such as arterial blood pressure or ETCO2 when
feasible to monitor and optimize CPR quality
ADULT ACLS HIGHLIGHTS

48.  The usefulness of double sequential defibrillation for refractory shockable rhythm has not
been established.
 Changing the direction of defibrillation current by repositioning the pads may be as
effective as double sequential defibrillation while avoiding the risks of harm from
increased energy and damage to defibrillators
 Reasonable for providers to first attempt establishing IV access for drug administration in
cardiac arrest
 IO access may be considered if attempts at IV access are unsuccessful or not feasible.
ADULT ACLS HIGHLIGHTS cont…

65. AMERICAN CLINICAL NEUROPHYSIOLOGY SOCIETY
CRITERIA

68. OPIOID-ASSOCIATED EMERGENCY FOR HEALTHCARE
PROVIDERS ALGORITHM

69. Adult Bradycardia
Algorithm

71. Adult Tachycardia With a Pulse Algorithm

79. IV Medications Commonly Used for Acute Rate Control in Atrial
Fibrillation and Atrial Flutter

80. Cardiac Arrest in Pregnancy In-Hospital ACLS Algorithm

84.  Cardiac arrest survivors have multimodal rehabilitation assessment and treatment for
physical, neurologic, cardiopulmonary, and cognitive impairments before discharge from
the hospital.
 Cardiac arrest survivors and their caregivers receive comprehensive, multidisciplinary
discharge planning, to include medical and rehabilitative treatment recommendations and
return to activity/work expectations.
 Structured assessment for anxiety, depression, posttraumatic stress, and fatigue for cardiac
arrest survivors and their caregivers.
Care and Support During Recovery

87.  Debriefings and referral for follow up for emotional support for lay rescuers, EMS
providers, and hospital-based healthcare workers after a cardiac arrest event may be
beneficial.
Debriefings for Rescuers

88.  Incorporating repetition with feedback.
 Booster training (ie, brief retraining sessions) should be added to massed learning (ie,
traditional course based) to assist with retention of CPR skills. Provided that individual
students can attend all sessions, separating training into multiple sessions (ie, spaced
learning) is preferable to massed learning.
 In situ training (ie, resuscitation education in actual clinical spaces) can be used to
enhance learning outcomes and improve resuscitation performance.
 Virtual reality, which is the use of a computer interface to create an immersive
environment, and gamified learning, which is play and competition with other students,
can be incorporated into resuscitation training for laypersons and healthcare providers
 All healthcare providers should complete an adult ACLS course or its equivalent
RESUSCITATION EDUCATION SCIENCE

89.  Survival after cardiac arrest requires an integrated system of people, training, equipment,
and organizations .
 Team feedback matters. Structured debriefing protocols improve the performance of
resuscitation teams in subsequent resuscitation.
 System-wide feedback matters. Implementing structured data collection and review
improves resuscitation processes and survival both inside and outside the hospital.
 Novel methods to use mobile phone technology to alert trained lay rescuers of events that
require CPR are promising and deserve more study.
 It is reasonable for organizations that treat cardiac arrest patients to collect processes-of-
care data and outcomes.
SYSTEMS OF CARE

90. SPECIAL CIRCUMSTANCES OF
RESUSCITATION

102. Amiodarone and lidocaine are now considered equivalent as antiarrhythmic in cardiac arrest scenarios.
For adult symptomatic bradycardia, atropine dose changed to 1 mg from 0.5 mg. Dopamine dose for this changed from 2-20 mcg/kg/minute to 5-20
mcg/kg/minute.
Emphasis on prevention of hyperoxia, hypoxemia and hypotension
Initial stabilization split in to manage airway, manage respiratory parameters and manage hemodynamic parameters.
For adult tachycardia IV access and ECG moved earlier in the algorithm.
Updated ACS algorithm contact to balloon inflation goal less than or equal to 90 minutes
Target SpO2 >94% for stroke and general care; 92-98% for post cardiac arrest care
During CPR, 15 seconds before pausing compressions, high performance team should check for pulse, precharge defibrillator, and prepare to deliver shock in 10
seconds or less to increase CCF>80% as 10% rise in CCF leads to 11% rise in survival
Feedback devices or metronomes(can be downloaded on mobiles too)
IV preferred over IO
New diagram to guide neuroprognostication
SUMMARY

103. 1. Highlights of the 2020 American Heart Association's Guidelines for CPR and ECC
2. 2023 American Heart Association Focused Update on Adult Advanced Cardiovascular
Life Support: An Update to the American Heart Association Guidelines for
Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
REFERENCE

104. THANK YOU