High-quality chest compressions and early defibrillation for treatable arrhythmias remain the cornerstones of basic life support (BLS) and advanced cardiac life support (ACLS). The most recent versions of the ACLS algorithms can be accessed online; access to copies within UpToDate is provided below.
Teams providing ACLS perform better when there is a single designated leader who asks for and accepts helpful suggestions from members of the team, and when the team practices clear, closed-loop communication.
●Initial interventions
Begin excellent cardiopulmonary resuscitation (CPR) immediately for any patient with suspected cardiac arrest. Excellent chest compressions have few interruptions, are delivered at the correct rate and depth, and allow complete chest recoil. Secondary interventions include performing ventilations, administering oxygen, establishing vascular access, initiating appropriate monitoring (cardiac, oxygen saturation, waveform end-tidal carbon dioxide [EtCO2]), and obtaining an electrocardiogram (ECG).
During initial life support of adults, high-quality chest compressions take priority over ventilation (circulation, airway, breathing [C-A-B]). When ventilating the patient in cardiac arrest, give 100 percent oxygen, use low respiratory rates (approximately six to eight breaths per minute), and avoid hyperventilation, which is harmful. Ventilation using a bag-valve-mask (BVM) or supraglottic airway is preferred when possible.
●ECG interpretation
For the purposes of ACLS, ECG interpretation is guided by three questions:
•Is the rhythm fast or slow?
•Are the QRS complexes wide or narrow?
•Is the rhythm regular or irregular?
●Arrhythmia management
The basic approach and important aspects of management for each arrhythmia covered by the ACLS Guidelines are discussed in the text and summarized in the accompanying algorithms. Patients with VF or VT are defibrillated as rapidly as possible. For patients with effective respiration and a palpable pulse, treatment is determined by the ventricular rate (tachycardiac or bradycardia) and clinical assessment of overall stability:
A single biphasic defibrillation is the treatment for VF or VT. CPR should be performed until the defibrillator is charged and resumed immediately after the shock is given without pausing to recheck a pulse.
