This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

Advanced Life Support

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Advanced life support protocols are for use in patients suffering a cardiac arrest.

The up-to-date guidelines for Advanced Life Support must be consulted. These are available from the UK Resuscitation Council website www.resus.org.uk

2021 guidelines (1) recommend:

  • CPR before defibrillation
    • during CPR, start with basic airway techniques and progress stepwise according to the skills of the rescuer until effective ventilation is achieved.
  • Continue CPR while a defibrillator is retrieved, and pads applied.
  • Give a shock as early as possible when appropriate.
  • Deliver shocks with minimal interruption to chest compression and minimise the pre-shock and post-shock pause.
  • This is achieved by continuing chest compressions during defibrillator charging, delivering defibrillation with an interruption in chest compressions of less than 5 seconds and then immediately resuming chest compressions.
  • defibrillation strategy (1)
    • increased emphasis has been placed on minimally interrupted high-quality chest compressions with brief pauses only for specific interventions.
    • chest compressions are continued until defibrillator charges
    • reduced emphasis on pre-cordial thump
  • ultrasound (1)
    • the potential benefit of ultrasound imaging during ALS is recognised.
  • Only skilled operators should use intra-arrest point-of-care ultrasound (POCUS).
  • POCUS must not cause additional or prolonged interruptions in chest compressions.
  • airway management (1)
  • If an advanced airway is required, only rescuers with a high tracheal intubation success rate should use tracheal intubation.
  • The expert consensus is that a high success rate is over 95% within two attempts at intubation.
  • Aim for less than a 5 second interruption in chest compression for tracheal intubation.
  • use capnography for the confirmation and monitoring of tracheal tube placement, quality of CPR, and provide early indication of return of spontaneous circulation (ROSC).
  • drugs (1)
  • Give adrenaline 1 mg IV as soon as possible for adult patients in cardiac arrest with a non-shockable rhythm.
  • Give adrenaline 1 mg IV after the 3rd shock for adult patients in cardiac arrest with a shockable rhythm.
  • Repeat adrenaline 1 mg IV every 3-5 minutes whilst ALS continues.
  • Give amiodarone 300 mg IV for adult patients in cardiac arrest who are in VF/pVT after three shocks have been administered.
  • Give a further dose of amiodarone 150 mg IV for adult patients in cardiac arrest who are in VF/pVT after five shocks have been administered.
  • Lidocaine 100 mg IV may be used as an alternative if amiodarone is not available or a local decision has been made to use lidocaine instead of amiodarone. An additional bolus of lidocaine 50 mg can also be given after five defibrillation attempts.
  • Consider thrombolytic drug therapy when pulmonary embolus is the suspected or confirmed as the cause of cardiac arrest.
  • Consider CPR for 60-90 minutes after administration of thrombolytic drugs.

Post-resuscitation care (2)

If return of spontaneous circulation (ROSC) is achieved, post-resuscitation care should be instigated immediately. This involves continued monitoring, organ support, correction of electrolyte imbalances and acidosis, and safe transfer to a critical care environment. A thorough search for potential aetiologies should be conducted, and risk factors for sudden cardiac arrest should be modified or treated.

A 12-lead ECG is recommended immediately after ROSC to determine whether signs of ST-elevation myocardial infarction (STEMI) are present.

 

References:

  1. Resuscitation Council (UK). Resuscitation Guidelines 2021.
  2. Panchal AR et al. Part 3: adult basic and advanced life support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020 Oct 20;142(16_suppl_2):S366-468.

Create an account to add page annotations

Add information to this page that would be handy to have on hand during a consultation, such as a web address or phone number. This information will always be displayed when you visit this page

The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

Connect

Copyright 2024 Oxbridge Solutions Limited, a subsidiary of OmniaMed Communications Limited. All rights reserved. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions receives funding from advertising but maintains editorial independence.