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New ACLS Guidelines

The American Heart Association evaluates research and reviews existing first aid and life support guidelines to determine what changes need to be made to improve the effectiveness of procedures such as Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS), Basic Life Support (BLS), and Cardiopulmonary Resuscitation (CPR). This assessment of guidelines occurs every five years.

Late in 2010, new ACLS guidelines were announced. Health Education Solutions (HES) will implement new modules that adhere to those standards in their courses for ACLS Certification and ACLS Recertification.

A-B-C to C-A-B, ACLS guidelines change priority of response

The A-B-C approach (Airway-Breathing-Circulation) has been changed to the C-A-B approach (Circulation-Airway-Breathing). The purpose of this new approach is to quickly initiate chest compressions for individuals with life-threatening heart problems in order to restore and maintain blood pressure. It primarily applies to CPR performed by a single rescuer. In the hospital setting and with teams, management of circulation and respirations are achieved simultaneously.

ACLS Chest Compression Changes

The newly mandated ACLS changes to chest compressions require that:

  • Depress the adult sternum at least 2 inches
  • Complete recoil of the chest is required
  • Chest compressions should be performed at a rate of at least 100/minute
  • Checking for a pulse in an unresponsive individual now requires less than 10 seconds so chest compressions aren’t delayed.

Remember, mistakenly doing chest compression on someone with a pulse does little harm compared to not doing compressions on someone without a pulse.

Quantitative Waveform Capnography Recommendation

To confirm and monitor endotracheal tube placement, use quantitative waveform capnography. The continuous measurement provides the partial pressure of exhaled carbon dioxide in mm Hg and it also provides a monitor of effective chest compressions. The return of spontaneous circulation can be difficult to assess, however it’s clearly demonstrated on the capnography measure by a sudden increase in co2 readings. Individuals who require endotracheal intubation are at risk of tube displacement during transport and transfer. The continuous waveform capnography will reflect these changes.

New Medication Protocols in ACLS Course

Four new medication protocols are covered in HES’ ACLS Classes.

  1. Due to the lack of any observed therapeutic benefit, atropine is no longer recommended to manage Pulseless Electrical Activity (PEA) or asystole.
  2. Adenosine is recommended for the treatment of stable, undifferentiated wide-complex Tachycardia when the rhythm is regular and the QRS waveform is monomorphic.
  3. Intravenous chronotropic agents are recommended as an effective alternative to external pacing for individuals with symptomatic or unstable bradycardia.
  4. Oxygen supplementation for uncomplicated acute coronary syndrome is no longer routinely indicated and should only be applied only if the oxyhemoglobin saturation is less than or equal to 94 percent.

Emergency Care Priorities

In order to avoid interruptions to chest compressions or delays in use of defibrillators, the use of advanced airways, gaining vascular access, and administering drugs doesn't take priority over high quality CPR and access to immediate defibrillation.

Post-Cardiac Arrest Care

A new ALCS guideline was created for Post-Cardiac Arrest Care. This ALCS guideline emphasizes a structured interdisciplinary system of care following a cardiac arrest. Therapeutic hypothermia treatment and percutaneous coronary interventions, such as coronary angiography with revascularization should be provided when indicated after cardiac arrest.

New Stroke Care Recommendations

The window of time to use thrombolytics (rTPA) is still within three hours of onset of stroke symptoms. However, select patients can be treated with TPA within four and one-half hours. Stroke care through regional systems of care and organized stroke units are recommended.

The talented neurologist can pull a lot of information about acute ischemic strokes on head CT. Watershed infarcts are more difficult to identify on CT but the clinical setting is usually the most helpful in diagnosis.

Previous ACLS Study Remains Valid

If you've been trained under the old guidelines, you aren't required to immediately take new ACLS courses. The new ACLS guidelines don't suggest that the earlier guidelines were unsafe or ineffective, and individuals trained under earlier guidelines should continue to perform to these standards until they are trained under the new guidelines. Course completion cards will continue to be recognized as valid for two years, regardless of ACLS procedural changes.