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ACLS - ADVANCED CARDIOVASCULAR LIFE SUPPORT PowerPoint Presentation

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Description : a set of clinical interventions for the urgent treatment of cardiac arrest and other life threatening medical emergencies, as well as the knowledge and skills to deploy those interventions.

Tags : ADVANCED CARDIOVASCULAR LIFE SUPPORT,ACLS,BLS,Cardiovascular Life Support

Published on : Aug 14, 2025 | Views : 123 | Downloads : 0

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Advanced Cardiac Life Support
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Definitions ACLS (Advanced Cardiovascular Life Support): a set of clinical interventions for the urgent treatment of cardiac arrest and other life threatening medical emergencies, as well as the knowledge and skills to deploy those interventions.
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DEFINITIONBLS,CPR,AED Basic life support (BLS) is the foundation for saving lives following cardiac arrest. Fundamental aspects of BLS include : immediate recognition of sudden cardiac arrest (SCA) and activation of the emergency response system, early cardiopulmonary resuscitation (CPR), and rapid defibrillation with an automated external defibrillator (AED).
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BLS-ACLS ACLS is an extension of BLS. BLS Primary survey. ACLS Secondary survey.
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Ischemia ACS Stroke Respiratory Arrest Arrest V-Fib Pulseless VT PEA Asystole Pre-Arrest Bradycardia Tachycardia Atrial fib/flutter ACLS Scenarios
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New Adult Cardiovascular Life Support Guidelines Robert W. Neumar, MD, PhD, FACEP University of Pennsylvania School of Medicine Immediate Past Chair, ACLS Subcommittee © 2010 American Heart Association. All rights reserved.
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Outline CPR Sequence Airway CPR Quality Management of symptomatic arrhythmias CPR Pharmacology Acute coronary syndrome Stroke Post-Cardiac Arrest PCI © 2010 American Heart Association. All rights reserved.
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CPR Sequence Change: From A-B-C to C-A-B Initiate chest compressions before ventilations Why? Goal: To reduce delay to CPR, sequence begins with skill that everyone can perform Emphasize primary importance of chest compressions for professional rescuers © 2010 American Heart Association. All rights reserved.
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CPR Starts with Compressions Many adults with witnessed arrest have ventricular fibrillation (VF)/pulseless ventricular tachycardia (VT), and require Chest compressions Early defibrillation Chest compressions can be started immediately (no equipment needed) Opening airway, providing ventilation may significantly delay other actions © 2010 American Heart Association. All rights reserved.
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Healthcare Provider ADULT BLS Sequence Recognize unresponsive adult with no breathing or no normal breathing (ie, only agonal gasps) Activate emergency response, retrieve AED (or send someone to do this) Check for pulse (no more than 10 seconds) If no pulse, begin sets of 30 chest compressions and 2 breaths Use AED as soon as available © 2010 American Heart Association. All rights reserved.
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© 2010 American Heart Association. All rights reserved. Airway
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2010 New Science: Airway Unrecognized endotracheal tube misplacement remains unacceptably high Wirtz, 2007, 213; Timmermann 2007, 619 Waveform capnography verifies tracheal tube position in victims of cardiac arrest with 100% sensitivity and 100% specificity. Silvestri, 2005, 497; Grmec 2002, 701;Trikha, 1999, 347; Tong, 2002, 159; Zaleski, 1993, 244; Holland, 1993, 608; Ko, 1993, 91; Linko, 1983, 199; Wayne, 1999, 107; Williamson, 1993,511 Confirmation and Monitoring of Endotracheal Tube Placement
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2010 New Science: Airway Non-waveform capnometry, colorometric EtCO2 detectors, and mechanical devices (syringe aspiration and inflating bulb esophageal detectors) do not exceed the accuracy of auscultation and direct visualization for confirming the tracheal position of a tracheal tube in victims of cardiac arrest. Capnometry: Takeda, 2003, 153; Tanigawa, 2001, 375; Tanigawa, 2000, Bozeman, 1996, 5951; Grmec, 2002, 701; Anton 1991, 271; Li, 2001, 223 Colorimetric ETCO2 detector: Ornato, 1992, 518; Anton, 1991, 271; MacLeod, 1991, 267; Varon, 1991, 289; Schaller, 1997, 57; Bhende, 1995, 395; Li, 2001, 223 Mecahnical devices: Tanigawa, 2001, 375; Pelucio, 1997, 563; Takeda, 2003, 153; Tanigawa, 2001, 375; Tanigawa, 2000, 1432 Confirmation and Monitoring of Endotracheal Tube Placement
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Endotracheal Intubation Continuous waveform capnography is recommended in addition to clinical assessment as the most reliable method of confirming and monitoring correct placement of an endotracheal tube (Class I, LOE A) Providers should observe a persistent capnographic waveform with ventilation to confirm and monitor endotracheal tube placement in the field, in the transport vehicle, on arrival at the hospital, and after any patient transfer to reduce the risk of unrecognized tube misplacement or displacement © 2010 American Heart Association. All rights reserved.
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Waveform Capnography After intubation, exhaled carbon dioxide is detected as a waveform corresponding to each breath confirming tracheal tube placement. End-Tidal CO2 (PETCO2) is the highest value at end-expiration. PETCO2 © 2010 American Heart Association. All rights reserved.
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© 2010 American Heart Association. All rights reserved. Management of Cardiac Arrest
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© 2010 American Heart Association. All rights reserved. Algorithms are simplified and redesigned to emphasize quality CPR
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© 2010 American Heart Association. All rights reserved.
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© 2010 American Heart Association. All rights reserved. CPR Quality Mechanical Parameters Push hard (≥2 inches [5 cm]) Push fast (≥ 100/min) Allow complete chest recoil Minimize interruptions in compressions Avoid excessive ventilation
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© 2010 American Heart Association. All rights reserved. CPR Quality Physiologic Parameters Quantitative waveform capnography If PETCO2 <10 mm Hg attempt to improve CPR quality Intra-arterial pressure If relaxation phase (diastolic) pressure <20 mm Hg attempt to improve CPR quality
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Waveform Capnography During CPR © 2010 American Heart Association. All rights reserved.
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Intra-Arterial Pressure During CPR © 2010 American Heart Association. All rights reserved. Arterial relaxation phase (diastolic) pressure < 20 mm Hg Arterial relaxation phase (diastolic) pressure 40 mm Hg Blood flow generated by CPR unlikely to result in ROSC Improved chance of ROSC
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Management of symptomatic arrhythmias
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adenosine can now be considered for the diagnosis and treatment of stable undifferentiated wide-complex tachycardia when the rhythm is regular and the QRS waveform is monomorphic. 2010 New Science: CPR Pharmacology
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atropine is no longer recommended for routine use in the management of pulseless electrical activity (PEA)/asystole. For symptomatic or unstable bradycardia, intravenous (IV) infusion of chronotropic agents is now recommended as an equally effective alternative to external pacing when atropine is ineffective. 2010 New Science: CPR Pharmacology
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Atropine: changed No longer recommended for routine use in management of PEA or asystole Epinephrine: unchanged Vasopressin: unchanged Amiodarone: unchanged Lidocaine: unchanged Sodium Bicarbonate: unchanged Routine use not recommended (Class III, LOE B). Calcium: unchanged Routine use not recommended (Class III, LOE B). © 2010 American Heart Association. All rights reserved. CPR Pharmacology
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Ischemia ACS Stroke Arrest V-Fib Pulseless VT PEA Asystole Pre-Arrest Bradycardia Tachycardia Atrial fib/flutter Acute Coronary Syndrome Respiratory a
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Ischemia ACS Respiratory Arrest Arrest V-Fib Pulseless VT PEA Asystole Pre-Arrest Bradycardia Tachycardia Atrial fib/flutter Ischemia: Stroke Stroke
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© 2010 American Heart Association. All rights reserved. Post-Cardiac Arrest Care
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Post-Cardiac Arrest Care 60-80% of patients that regain a pulse after cardiac arrest die before hospital discharge Implementation of comprehensive systems of care for post-cardiac arrest patients consistently results in improved survival with good neurologic function © 2010 American Heart Association. All rights reserved.
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Post-Cardiac Arrest Care A comprehensive, structured, multidisciplinary system of care should be implemented in a consistent manner for the treatment of post-cardiac arrest patients (Class I, LOE B) Programs should include: Therapeutic hypothermia Optimization of hemodynamics, ventilation, and oxygenation Immediate coronary reperfusion with PCI when indicated Glycemic control Neurological diagnosis, management, and prognostication © 2010 American Heart Association. All rights reserved.
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© 2010 American Heart Association. All rights reserved.
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Post-Cardiac Arrest Hypothermia Comatose (ie, lack of meaningful response to verbal commands) adult patients with ROSC after out-of-hospital VF cardiac arrest should be cooled to 32°C to 34°C (89.6°F to 93.2°F) for 12 to 24 hours (Class I, LOE B) Induced hypothermia also may be considered for comatose adult patients with ROSC after in-hospital cardiac arrest of any initial rhythm or after out-of-hospital cardiac arrest with an initial rhythm of pulseless electric activity or asystole (Class IIb, LOE B) © 2010 American Heart Association. All rights reserved.
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Post-Cardiac Arrest ACS/AMI A 12-lead ECG should be performed as soon as possible after ROSC (Class I, LOE A). Appropriate treatment of ACS or STEMI, including PCI or fibrinolysis, should be initiated regardless of coma (Class I, LOE B). Coma and the use of induced hypothermia are not contraindications or reasons to delay PCI or fibrinolysis. © 2010 American Heart Association. All rights reserved.
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Post-Cardiac Arrest Primary Percutaneous Coronary Intervention (PPCI) For patients with out-of-hospital cardiac arrest due to VF in the setting of STEMI (or new or presumably new LBBB), emergent angiography with prompt recanalization of the infarct-related artery is recommended (Class I, LOE B) PPCI after ROSC in subjects with arrest of presumed ischemic cardiac etiology may be reasonable, even in the absence of a clearly defined STEMI (Class IIb, LOE B) © 2010 American Heart Association. All rights reserved.
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Pediatric ACLS 15:2 ratio for 2-rescuer infant or child CPR with a pause for ventilation in patients without an advanced airway. and continuous compressions without a pause for ventilation plus a ventilation rate of about 8–10 breaths/minute for patients with an advanced airway. Recommended compression depth of at least one third of the chest A.P dimension or 4 cm (1.5 inches) in infants and 5 cm (2 inches) in children.
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Pediatric ACLS compression-ventilation ratio of 3:1 for resuscitation of the newly born in the delivery room, with a pause for ventilation The recommendation of an initial dose of 2 to 4 J/kg.
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© 2010 American Heart Association. All rights reserved.