What Are the 4 Core Objectives of ACLS?

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What Are the 4 Core Objectives of ACLS in 2022?

What is Advanced Cardiac Life Support (ACLS)?

Advanced Cardiovascular Life Support (ACLS) is designed to increase the chance of resuscitating a patient (ROSC), improve life-threatening conditions, and provide treatment to a patient experiencing abnormal heart rhythms and cardiac events.

ACLS is most effective with an initial and subsequent accurate assessment of the patient and reassessment during each treatment phase. These ACLS protocols were developed by registered and licensed medical professionals who adhere to the gold standard set by the International Liaison Committee on Resuscitation (ILCOR) and have been updated in compliance with the latest American Heart Association (AHA) guidelines (2020).

RELATED: An ACLS Certification Guide for 2023 Medical Candidates

What are the ACLS Advanced Cardiac Life Support Objectives?

The goal of ACLS is to strengthen your ability to respond to cardiac arrest or emergent cardiac episodes, whether in-hospital (IHCA) or out-of-hospital (OHCA). ACLS providers must be proficient in their ability to communicate and work effectively within a resuscitation team in order to work towards the best possible outcome for their patient. Built on a solid foundation of Basic Life Support (BLS) and resuscitation team training, the main objectives of ACLS include:

  1. airway management and ventilation
  2. CPR compressions
  3. defibrillation (and integrated use of a defibrillator with chest compressions)
  4. medication access routes and pharmacology

Recently, the AHA has also emphasized recovery as an important aspect of the ACLS Chain of Survival, and could also be considered one of the goals of ACLS. The Recovery stage can and should take up to a full year, and includes regular check-ups and monitoring, as well as the provision of counselling to support the psychological well-being of the patient post-traumatic event.

RELATED: American Heart Association’s Acute Coronary Syndrome Algorithm

1. Airway management and ventilation

There are 2 categories of airway management used in ACLS: basic airway and advanced airway.

Basic airway management is used in BLS and ACLS and includes:

  • mouth-to-mouth
  • mouth-to-mask
  • bag-mask ventilation (BMV)
  • Oropharyngeal airway (OPA)
  • Nasopharyngeal airway (NPA)

Advanced airway management is used in ACLS and includes:

  • Esophageal-tracheal tube
  • Endotracheal (ET)
  • Laryngeal tube
  • Laryngeal mask airways (LMA)

Providers will determine the necessity of intubation during the Primary Assessment. However, CPR should continue without an advanced airway if bag-mask ventilation is adequate or perfusion would be affected when interrupting CPR. When an advanced airway is placed, however, do not interrupt compressions to give breaths—give one breath every 6 seconds; this is called asynchronous ventilation.

2. CPR compressions

One cycle of CPR for an adult without an advanced airway includes 30 chest compressions and two breaths at a rate of 100–120 bpm, at a depth of 2.4 inches into the chest. If the person has an advanced airway, the provider giving rescue breaths should provide one asynchronous ventilation every 8–10 seconds (six to eight breaths per minute). Asynchronous ventilations do not need to be coordinated with chest compressions.

3. Defibrillation

Defibrillation with an AED provides an external shock that simultaneously depolarizes all heart muscle cells, stops the disordered electrical activity, and allows the heart’s natural pacemakers to return to a normal rhythm. The energy dose of a defibrillator depends on the type–monophasic (which delivers 360J) or biphasic. Biphasic is more effective in terminating fatal arrythmias by using more than one waveform variety as wells as providing the recommended energy dose of the device.

When using a defibrillator, providers should reduce interruptions of chest compressions while it is charging. Remove any external oxygen and shout “Clear” before administering a shock to declare that no one should be touching the victim. Resume chest compressions immediately after the shock.

4. Medication access routes and pharmacology

ACLS providers administer medications and fluids through intravenous, intraosseous, and endotracheal tube routes. IV access is the preferred route of medication administration, but IO is acceptable if IV access is not available. However, endotracheal absorption of medications is poor, and although higher medication doses are given via ET tube than IV or IO, optimal drug dosing is not known. If a medication is given via the ET tube, CPR will need to be briefly interrupted so that the drug doesn’t regurgitate up the ET tube.

RELATED: ACLS Drugs that are Commonly Administered Via Endotracheal Tube (ETT)

Medications used in ACLS include:

In order to keep current and knowledgable on the proper dosages, uses and access routes for these ACLS drugs, a provider must be trained and certified in ACLS, and updated every 2–5 years as research in cardiac treatments evolve.

RELATED: The Correct Dopamine Dose and Use Advanced Cardiac Life Support (ACLS)

Where Do I Go to Learn More about ACLS Objectives?

Two healthcare professionals study a chart.
Two healthcare professionals study a chart

RELATED: The 5 Must-Know ACLS Questions (and Answers) For Your 2022 ACLS Exam

You can learn more about ACLS and its objectives by taking an ACLS certification course. This certification is in fact mandatory for anyone working in advanced cardiac life support, whether it be first-responders (EMTs) or nurses or doctors working in-hospital.

MedicalProCerts offers online ACLS training and certification. It covers all of the ACLS objectives as outlined above, in addition to the provision of recovery following cardiac episodes.

You can also go to www.medicalprocerts.com to learn more about the ACLS Certification course, and get started (and certified) today!

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