Preview ACLS

Algorithm
 Protocols for Adult Advanced Cardiac Life
Support
Recommendations
1.That the Adult ACLS algorithm be used as a tool to
manage all adults who require advanced life support.

2.Good quality CPR and reducing time to defibrillation

are the
highest priorities in resuscitation from sudden cardiac
arrest.

3.Rescuers should aim to minimise interruptions to CPR

during any ACLS intervention.
 What seems to work?
• Performing ACLS
correctly is associated
with an improvement in
outcome
• Compared guideline
adherence for survivors
vs. non-survivors
– 75 survivors
– 75 non-survivors
• Survivors older and with
more cormorbidities

Resuscitation. 2013;85:82-87
Resuscitation. 2013;85:82-87
• Each 10% improvement
in adherence results in
a ˜30% increase in
ROSC.

Resuscitation. 2013;85:82-87
 What is Recommended
• Defibrillation
• Chest Compressions
• Oxygenation
• Medications
• Procedures
 Chest Compressions
• Place patient on a firm surface
– Backboard
– Deflation of air mattress
• Had in the middle of the chest
– 5 cm of depression
– Allow complete recoil
• Lifting the hand completely of the chest can improve
recoil

Circulation. 2010;122:S685-705
CPR
• Depth: 5cm
• Rate: 100-120bpm
• Minimise interruptions
• Cycle every 2 minutes or more frequently of
required
• ETCO2 < 10mmHg = inadequate compressions
Monomorphic VT
Polymorphic VT
Polymorphic VT/TdP
VF
 Shockab
• 200 J shock
le
(biphasic)

• Recommended it is
CPR 2 reasonable to
minutes
increase energy
level for
subsequent shocks.
CPR for 2 minutes
1mg Adrenaline
IV/IO (1 in 1000)
Then every 2nd
cycle

CPR for 2
minutes
Amiodarone
300mg IV/IO
Non shockable
 Non
shockable

1mg Adrenaline
IV/IO (1 in
1000)

CPR 2
minutes

CPR 2
minutes
Reversible causes
4 H’s & 4 T’s

• Hypoxaemia
• Hypovolaemia
• Hyper/hypokalaemia & metabolic
disorders
• Hypo/hyperthermia
• Tension pneumothorax
• Tamponade
• Toxins / poisons / drugs
• Thrombosis-pulmonary / coronary
 Cardioversion
Rhythm Energy level (biphasic)
Atrial fibrillation 120-200 J (synchronised)
Atrial flutter 50-100 J (synchronised)
SVT 50-100 J (synchronised)
Pulsed VT 100 J (synchronised)
VF/Pulseless VT 200 J (consider increasing if
unsuccessful)
Algorithms for Advanced Cardiac Life
Support 2018
 Summary
• All cardiac arrests should follow the ALS
algorithm

• Good quality CPR with minimal interruptions

including

• Resuscitate with 100% O2

• Early defibrillation

• Consider higher energy levels if 1st shock

unsuccessful
Thank You