Advanced Cardiac Life Support(ACLS)

Department of Anesthesia Presented by :

Swornim Gyawali

impacts multiple key links (chain of survival )thatinclude

1. interventions to prevent cardiac arrest,

2. treat cardiac arrest, and

3. improve outcomes of patients who achievereturn of spontaneous circulation (ROSC) aftercardiac arrest

Interventions aimed at preventing cardiac arrestairway management,

ventilation support, and

treatment of bradyarrhythmias andtachyarrhythmias

AHA Adult Chain of Survival

1. recognition of cardiac arrest activation of the emergency response

2. Early CPR (emphasis on chest compressions)

3. Rapid defibrillation

4. Effective advanced life support

5. post–cardiac arrest care

CHANGES FROM THE 2005 BLS

• Recognition of SCA(unresponsiveness and absence of normal breathing )

• “Look, Listen, and Feel” removed

• Encouraging CPR

• Sequence change CAB rather than ABC

• simplified adult BLS algorithm

Cardiac arrest can be caused by 4 rhythms:

1. Ventricular fibrillation(VF),

2. Pulseless ventricular tachycardia (VT),

3. Pulseless electric activity (PEA), and

4. Asystole.

Treatable Causes of Cardiac Arrest: The H’s and T’s

H’s T’s

• Hypoxia Toxins

• Hypovolemia Tamponade (cardiac)

• Hydrogen ion(acidosis) Tension pneumothorax

• Hypo-/hyperkalemia Thrombosis, pulmonary

• Hypothermia Thrombosis, coronary

Shock Energy

• Biphasic : Manufacturer recommendation (eg, initial dose of 120-200 J), if unknown, use maximum available.

• Second and subsequent doses should be equivalent, and higher doses may be considered.

• Monophasic : 360 J(Note : If 1 shock fails to eliminate VF, the incremental benefit of another shock is low, and resumption of CPR is likely to confer a greater value than another shock)

Drug therapy

1. Peripheral IV Drug Delivery2. IO Drug Delivery - IO cannulation provides

access to a noncollapsible venous plexus3. Central IV Drug Delivery - It can be used to

monitor ScvO2 and estimate CPP during CPR, both of which are predictive of ROSC

4. Endotracheal Drug Delivery - lidocaine, epinephrine, atropine, naloxone, and vasopressin

• Dose : 2 to 2 ½ times the recommended IV dose

Drug Therapy

• Epinephrine IV/IO Dose: 1 mg every 3-5 minutes

• Vasopressin IV/IO Dose: 40 units can replace first or second dose of epinephrine

• Amiodarone IV/IO Dose: First dose: 300 mg bolus. Second dose: 150 mg.

• Lidocaine

indication : PVCs, Vtach, Vfib

IV dose :1-1.5 mg/kg bolus then continuous infusion of 2-4 mg/min

Toxicity:slurred speech, seizures, altered consciousness

– Epinephrine ( alpha, beta-1, and beta-2 stimulation, it increases heart rate,stroke volume and blood pressure)

– Indication : vfib ; asystole ; PEA

• IV dose: 1 mg every 3-5 minutes

• Vasopressin

Similar effects to Epinephrine

IV dose = 40 IU

better for asystole

• Amiodarone

Indications: Vtach, Vfib

IV Dose: 300 mg in 20-30 ml of N/S or D5W

Followed with continuous infusion of 1 mg/min for 6 hours than .5mg/min to a maximum daily dose of 2 grams

c/I : Cardiogenic shock/Sinus Bradycardia/2nd and 3rd

degree blocks

Key changes from the 2005 ACLS Guidelines

1. Continuous quantitative waveform capnography is recommended

2. Cardiac arrest algorithms are simplified and redesigned to emphasize the importance of high quality CPR

3. Atropine is no longer recommended for routine use in the management of pulseless electrical activity (PEA)/asystole

4. Adenosine is recommended as a safe and potentially effective therapy in the initial management of stable undifferentiated regular monomorphic wide-complex tachycardia

THANK YOU