Advanced cardiac life support
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Advanced cardiac life support (ACLS) is a detailed medical protocol for the provision of lifesaving cardiac care in settings ranging from the pre-hospital environment to the hospital setting.
ACLS is the appropriate medical response to cardiac arrest. In apparently healthy adults, cardiac arrest often occurs out of hospital. Early defibrillation is important to successful resuscitation, and early access defibrillation programs with the use of automated external defibrillators may further improve the success ratio. Introduction of ACLS in the pre-hospital environment has greatly improved the success ratio over transporting the cardiac arrest victim to ACLS care in the hospital. Active treatment hospitals often have special "crash" teams to respond to in-hospital cardiac arrests. Guidelines for the cessation of resuscitation of the cardiac arrest victim have been developed.
The Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care (ACLS) are published regularly in JAMA[1] (http://jama.ama-assn.org/cgi/content/extract/285/10/1267?maxtoshow=&HITS=80&hits=80&RESULTFORMAT=&fulltext=emergency+cardiac+care&searchid=1110903812049_1282&stored_search=&FIRSTINDEX=0). In the United States, the American Heart Association is the major source for ACLS courses and textbooks.
ACLS consists of CPR and Emergency Cardiovascular Care (ECC) through the provision of advanced cardiac drugs including epinephrine and atropine; electrical therapy of defibrillation and cardioversion; and advanced airway control including intubation and RSI. For healthcare professionals who witness or observe a monitored arrest, ACLS also includes a single precordial thump.
Paramedics, doctors, or specially trained nurses may provide ACLS before arrival in hospital, in the emergency room, or elsewhere in a hospital. Doctors trained in emergency medicine or cardiology can provide additional cardiac drugs and possible surgical intervention including internal cardiac massage and drainage of pneumothoraces and cardiac tamponade.
CPR provided by laypersons buys time for higher medical responders such as paramedics to arrive and begin providing ACLS. For this reason it is essential that any person starting CPR also activate the emergency medical services by calling for help using the emergency telephone number.
Semi-automatic defibrillation, oxygen, and airway support may be provided by emergency medical technicians. This is considered basic life support or BLS. Cardiopulmonary resuscitation (CPR) is one of the skills provided as part of BLS.
The automated external defibrillator (AED) has been developed for use by the lay public.
See also
External links
- British Heart Foundation (http://www.bhf.org.uk) includes good glossary, and details of heart health
- American Heart Association (http://www.americanheart.org/)
- UK Resuscitation Council (http://www.resus.org.uk/)
- European Resuscitation Council (http://www.erc.edu) includes the European 2000 guidelinesko:ACLS