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When it comes to saving lives, efficiency is key. In order to make sure that protocols for life-saving procedures are up to date, the American Heart Association evaluates existing guidelines and examines available research every five years in order to determine whether changes need to be made.

The most recent updates for advanced cardiac life support (ACLS), pediatric advanced life support (PALS), basic life support (BLS) and cardiopulmonary resuscitation (CPR) were announced in late 2010. Updates for ACLS, online PALS certification and BLS certification have been added to Health Education Solutions courses.

Michael Huckabee, PhD, PA-C, director of the Union College Physician Assistant program and curriculum developer for Health Education Solutions, explained the following important changes to ACLS guidelines:

Changes in Chest Compression Guidelines

When performing a life saving procedure that requires chest compressions, the compressions should depress the adult sternum at least 2 inches and complete recoil of the chest is required. Previously, guidelines only recommended 1 ½ to 2 inches. The recommendation for the rate of chest compressions has also been changed from about 100 per minute to at least 100 per minute. Additionally, ACLS guidelines now state that checking for a pulse on an unresponsive victim should take less than 10 seconds in order to avoid delaying chest compressions – it is more harmful to delay chest compressions on someone without a pulse than it is to mistakenly do chest compressions on someone with a pulse.

A-B-C is now C-A-B

Previously known as the A-B-C approach (Airway-Breathing-Circulation), ACLS guidelines now call for the C-A-B approach (Circulation-Airway-Breathing) when performing CPR as a single rescuer. Immediately initiating chest compressions helps maintain blood flow for individuals with life-threatening loss of heart function. When a team is performing CPR, management of respirations and circulations can happen simultaneously.

New Medication Guidelines

The updated guidelines include four new recommendations for medication protocol:

1. Adenosine is recommended for the treatment of stable, undifferentiated wide-complex tachycardia when the rhythm is regular and the QRS waveform is monomorphic.

2. Atropine is no longer recommended for routine use to manage asytole or pulseless electrical activity (PEA) due to a lack of therapeutic benefit.

3. Oxygen supplementation is no longer routinely indicated for uncomplicated acute coronary syndromes and should only be applied if the oxyhemoglobin saturation is less than or equal to 94 percent.

4. Intravenous chronotopic agents are recommended for individuals with symptomatic or unstable bradycardia as an alternative to external pacing.

Recommendations for Quantitative Waveform Capnography

Use of quantitative waveform capnography is recommended for confirmation and monitoring of endotracheal tube placement. The continuous measurement provides the partial pressure of exhaled carbon dioxide in mm Hg over time. Patients that require endotracheal intubation are at risk of tube displacement during transport and transfer. The continuous waveform capnography reflects any changes and provides a monitor of effective chest compressions. The return of spontaneous circulation, which is otherwise difficult to identify, is clearly shown on the capnography measure by a sudden increase in the CO2 readings.

New Section for Post-Cardiac Arrest Care

The new ACLS guidelines include a section for Post-Cardiac Arrest Care that emphasizes a structured system of care for a patient following a cardiac arrest. Therapeutic hypothermia treatment and percutaneous coronary interventions should be provided when indicated after a cardiac arrest.

Recommendations for Stroke Care

Guidelines recommend stroke care through regional systems of care and organized stroke units, while prehospital treatment of blood pressure is de-emphasized. Additionally, while it is still recommended that thrombolytics (rTPA) are used within three hours of onset of stroke symptoms, the window of time can be extended to be within four and one-half hours after symptoms onset for selected patients.

Priorities for Emergency Care

Using advanced airways, gaining vascular access and administering drugs should not take priority over high quality CPR and access to immediate defibrillation. This recommendation is made in order to avoid interruptions to chest compressions or delays in use of defibrillators.

Previous ACLS/PALS Certification Remains Valid

Healthcare professionals trained under old ACLS guidelines are not required to immediately take a new course. The previous guidelines are still considered safe and effective, and individuals trained under earlier guidelines should continue to perform under the standards they learned until they are trained under the new protocols. ACLS/PALS certification will continue to be recognized as valid for a two-year period, regardless of procedural changes.


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