What Is Advanced Cardiac Life Support?
Advanced cardiac life support (ACLS) is a group of guidelines used by medical providers that immediately treat life-threatening conditions, including cardiac arrest, stroke, shock, and trauma. ACLS is not meant to reverse or cure an underlying life-threatening or end-stage condition, but it aims to stabilize the patient's condition by restoring the patient's vital signs and alertness. However, not all cases are successful.
These techniques and procedures are arranged into algorithms, which is a set of standard guidelines to enhance ACLS's effectiveness, speed, and outcomes. ACLS algorithms mostly address five aspects of peri-cardiac arrest care, including airway management, CPR compressions, ventilation, defibrillation, and medications. These standardized algorithms are followed due to the seriousness of the diseases treated, the lack of information about most ACLS patients, and the requirement of spontaneous multiple treatments. The success of ACLS treatment usually needs a team of trained healthcare professionals, including a leader, backup leader, an airway or respiratory specialist, two cardiopulmonary resuscitation (CPR) performers, medication administration and an intravenous (IV) access specialist, a defibrillator attendant, a lab member to send samples, a pharmacist, and a recorder to document the treatment.
What Are the Different Types of Treatment Involved in ACLS?
There are many different procedures involved in ACLS. Some conditions and diseases may require few ACLS procedures and techniques, while others may require many procedures.
1) Cardiopulmonary Resuscitation (CPR) -This is performed to keep the supply of oxygenated blood through the body until the heart can perform this function on its own. It can be achieved by chest compression (pushing down fast and firmly on the chest using two hands) or mechanical CRP using the Lund University Cardiopulmonary Assist System (LUCAS) device.
2) Rhythm Diagnosis - This is performed to diagnose the correct rhythm that is causing cardiac arrest. It can be done through clinical examination and electrocardiography (EKG).
3) Electrotherapy - High energy electrical stimulus generated will pass through the conduction pathways and make the heart's ventricles contract and pump out blood. It can be performed through. It can be performed through Mono- or biphasic defibrillation, double sequential defibrillation, transcutaneous pacing, and transvenous pacing.
4) Airway Management - Airway stabilization and management, including placing a breathing tube in the windpipe, referred to as intubation. Mechanical ventilation is provided through ventilator assistance.
5) Arterial Line Insertion - This helps to take continuous blood pressure readings. It also includes a catheter, which helps to draw blood when required.
6) Cardioversion - This helps to treat conditions like abnormal heartbeats (cardiac arrhythmias) by using low-energy electrical shocks or medications to restore a normal heartbeat.
7) Chest Tubes or Needle Decompression - It is used to re-inflate a collapsed lung.
8) Catheter Placement - Intravenous (IV) or central venous catheter may be attached to deliver medications, fluids, and blood transfusions.
9) Medications - Different drugs like Epinephrine, Norepinephrine, Atropine, Amiodarone, Lidocaine, Sotalol, Albuterol, Vasopressin, Procainamide, calcium chloride, magnesium, and crystalloid fluids are used during ACLS. These medications can reverse life-threatening allergic reactions, suppress abnormal heartbeats, and correct acidosis (too much acid in the body fluids). They can also reduce the heart's workload, dissolve clots responsible for heart attacks, and reduce fluid buildup. Additionally, they can improve blood pressure and vital signs.
Why Is ACLS Performed?
ACLS is performed to treat severe or life-threatening conditions, including:
-
Coma caused due to stroke, head injury, meningitis, seizures, or diabetes.
-
Severe heart conditions like cardiac arrest, heart attack, congestive heart failure, certain congenital heart defects, and abnormal heartbeats.
-
Chemical exposure and drug toxicity, like poisoning, overdose, or serious adverse effects of certain drugs and street drugs.
-
Arrhythmias (irregular heartbeat) like ventricular tachycardia, ventricular fibrillation, rapid atrial fibrillation, and supraventricular tachycardia.
-
Electrolyte imbalance due to varying amounts of calcium, potassium, or magnesium in the blood.
-
Respiratory failure includes problems due to pulmonary edema (excess fluid in the lungs), asthma, and pulmonary embolism (a blood clot that blocks blood flow to the lungs).
-
Severe allergic reactions, including anaphylaxis.
-
Shock, including shock due to excessive bleeding, injury, sepsis, and heart conditions.
-
Terminal illnesses include advanced cancer and last-stage liver failure.
-
Trauma and injuries, including major cuts, head and spinal cord injuries, severe burns, and multiple trauma.
Who Can Perform ACLS?
Advanced cardiac life support is generally performed by highly trained paramedics and other ACLS-certified healthcare professionals. As ACLS is complex needs speedy treatment, and should be performed in a standardized fashion, ACLS providers must hold certifications in ACLS care. The certifications for ACLS may be provided by a few organizations, generally by national organizations, and its legitimacy is often checked by the hospital or privileged boards hiring.
ACLS certifications generally provide insight into airway management, CPR compressions, ventilation, defibrillation, and medications, except for specialized resuscitation techniques. ACLS education is based on the International Liaison Committee on Resuscitation (ILCOR) recommendations.
BLS proficiency is usually required before ACLS training. However, in the initial portions of an ACLS class, CPR procedures will be taught. Initial training includes both classroom instruction and hands-on simulation experience and usually takes around 15 hours. Finally, passing a test with a practical component is usually required to receive certification. After certification, providers must usually recertify after every two years with similar content. The class will last about seven hours. Widely accepted ACLS certification providers include the American Red Cross, the American Heart Association, the Australian Resuscitation Council, and the European Resuscitation Council.
What Is the Difference Between Basic Life Support and Advanced Cardiac Life Support?
Basic life support (BLS) is the basic step performed to stabilize a patient. The BLS aims to help the patient during an emergency until the arrival of emergency medical services for further assessment. BLS is performed with cardiopulmonary resuscitation (CPR) and an automated external defibrillator (AED), whereas no drugs will be used. BLS includes topics such as:
-
Performing CPR.
-
Performing the Heimlich Maneuver.
-
Using an AED.
Advanced cardiac life support is a highly professional technique, so medical knowledge is required to perform this procedure. ACLS is generally performed by initiating IV access, recording electrocardiograms, and administering emergency drugs. ALS includes topics such as:
-
Effective airway control.
-
Respiratory issues and cardiac arrest management.
-
ALS pharmacology terms and their meaning.
-
Stroke and acute coronary syndromes management.
-
Performing as a leader and team member in a resuscitation team.
Some other key differences between BLS and ACLS include the following:
-
A BLS provider cannot perform invasive procedures and can administer only a few selective medications. ACLS providers do invasive procedures and provide a wide array of medications.
-
An ALS unit has more advanced airway equipment, a cardiac monitor, and more.
-
A BLS unit has two emergency medical technicians, whereas an ALS unit has at least one paramedic.
Conclusion
Advanced cardiac life support is a life-saving medical procedure performed by certified professionals. It cannot treat the underlying disease or condition but can stabilize critically ill patients. There are different numbers of ACLS procedures; depending on the patient's condition, the procedure may vary.
