Advanced cardiac life support (ACLS): Clinical

Advanced cardiac life support, or ACLS, is a structured way to respond to an unresponsive person with cardiac arrhythmias and cardiac arrest.

ACLS can be done by an individual or by a team that’s led by a team leader.

When we suspect a person may be in need of assistance, the first thing we need to do is determine their level of consciousness.

Talk loudly at them, rub their sternum, or apply pressure to their nail beds or ear lobes, while simultaneously checking for absent or abnormal breathing.

If they're not responsive, check their carotid pulse for about 10 seconds. If there's no pulse, first immediately activate the emergency response system to get more help and an AED or defibrillator. Then, move on to the ACLS algorithm.

The first thing to do is cardiopulmonary resuscitation or CPR, which combines chest compressions and artificial ventilation.

The big picture goal of CPR is to maintain blood flow to the brain while a patient is pulseless. Because the patient’s heart is not functioning, the team is mechanically squeezing the heart to ensure blood flows to the brain.

In a person over 8 years of age, chest compressions are done by placing the heel of one hand in the center of the chest, then placing the other hand on top, interlocking the fingers, and without flexing the elbows, pushing down on the chest to a depth of at least 5 centimeters or 2 inches - which is about the same size as a closed fist lengthwise.

Compressions are done at a rate of about 100 compressions per minute, which you can remember if you do them to the beat of “Staying alive” by the Bee Gees.

Additionally, the team attempts to artificially ventilate the patient so oxygen can enter the lungs and carbon dioxide can leave the lungs.

Artificial ventilation includes a variety of ways to assist respiration for a person who isn’t breathing or making sufficient respiratory effort on their own.

The options for ventilation usually involve a bag valve mask device to push air in.

A bag valve mask can be applied directly to the person’s mouth, or with an oral airway, a supraglottic airway like a laryngeal mask airway or LMA, or an endotracheal tube.