Preview ACLS

Algorithm
ProtocolsforAdult AdvancedCardiacLifeSupport

Recommendations
1.That the Adult ACLS algorithm be used as a tool to manage
all adults who require advanced lifesupport.

2.Good quality CPR and reducing time to defibrillation are the

highest priorities in resuscitation from sudden cardiacarrest.

3.Rescuers should aim to minimise interruptions to CPRduring

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
MonomorphicVT
PolymorphicVT
PolymorphicVT/TdP
VF
 Shockable • 200 Jshock(biphasic)

• Recommended it is
CPR2 minutes reasonable to increase
energy level for
subsequent shocks.
CPRfor 2 minutes
1mg Adrenaline IV/IO
(1 in 1000)
Then every 2nd cycle

CPRfor 2 minutes
Amiodarone 300mg
IV/IO
Nonshockable
 Non shockable

1mg Adrenaline IV/IO

(1 in 1000)

CPR2 minutes

CPR2 minutes
 Reversiblecauses
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 ALSalgorithm

• Good quality CPRwith minimal interruptions including

• Resuscitate with 100% O2

• Early defibrillation

• Consider higher energy levels if 1st shockunsuccessful

Thank You