What is Advanced Cardiac Life Support?

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  • Written By: M. DePietro
  • Edited By: W. Everett
  • Last Modified Date: 13 October 2019
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Advanced cardiac life support, or ACLS, is an algorithm of medical interventions used to treat certain medical emergencies, such as cardiac arrest and stroke. Medical personal, such as paramedics, doctors, nurses, and respiratory therapists must take a certification class to learn ACLS procedures prior to administering them. The algorithms are complex and should only be carried out by trained medical providers.

The American Heart Association first developed advanced cardiac life support guidelines in 1974 as a cardiac arrest treatment. As research indicates what improves survival of medical emergencies, the guidelines are updated. The most recent update was in 2005.

Classes to become certified in ACLS are offered through hospitals, colleges, and private organizations. Managing the airway, analyzing various cardiac rhythms, and understanding what medications should be given are included in the class. Written evaluation and a hands-on practical exam are required to pass the class. The certification must be renewed every two years to remain valid.

A primary assessment is completed first in all medical emergencies and is part of the protocol during advanced cardiac life support. A primary survey includes determining if the person is responsive, if the airway is open, and if the person is breathing or has a pulse. Attaching electrodes to the patient’s chest, which are connected to a heart monitor, to identify the heart rhythm is the next step in the primary survey.


Identifying the abnormal rhythm is essential in cardiac arrest treatment. ACLS is organized into different treatment algorithms based on the symptoms and cardiac rhythm the patient is experiencing. The ACLS provider interprets the rhythm and proceeds to the algorithm that corresponds to the identified cardiac arrhythmia. There is also an algorithm for stoke patients based on symptoms.

After the primary survey, the ACLS provider will provide interventions as needed. Insertion of a breathing tube into the airway may be needed to assist with breathing. CPR may also need to be started.

An intravenous line should be inserted in order to administer medications. Various medications are part of advanced cardiac life support, including atropine, epinephrine, and lidocaine. The medication given depends on the abnormality. The patient may also need a cardioversion, which is done by using a defibrillator to convert the heart into a normal rhythm. A cardioversion is not indicated in all abnormal rhythms.

One of the last components of advanced cardiac life support protocols is making a diagnosis and treating reversible underlying causes of cardiac arrest. For example, a drug overdose may be treated with certain medications. Hypoxia leading to a cardiac arrest may be treated with oxygen. Reversing the underlying cause may help restore the heart to a normal rhythm.


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