The American Heart Association comes out with a new version of their guidelines for BLS and ACLS every five years. Changes to the guidelines are designed to reflect current research and care standards with an emphasis put on the ultimate survival of every patient. The most recent set of guidelines came out in 2015, and if you’ve not renewed your ACLS certification recently, you’ll definitely want to recognize these changes.
Updates to AHA ACLS Guidelines
In the 2015 guidelines, which will stay in place until 2020, there are numerous changes in how things are worded. Many small changes have been made to recognize that many first-responders are not trained in CPR or resuscitation. For example, the AHA now makes mention of social media as an acceptable way to call other responders to an area where someone may be suffering from cardiac arrest. This certainly reflects our changing times.
However, the pieces that will be most important for you to focus on are those that will impact your in-hospital care of your patient who goes into sudden cardiac arrest or who has a dangerous rhythm. The changes in these situations are designed to reflect the best practices of our day based on many studies, such as those that reflect survival rates. In particular, be sure to note the following four most major changes in the 2015 guidelines.
Vasopressin
Vasopressin was once listed as being all right to use in place of one of the first doses of epinephrine. In general, it was a provider’s choice as to whether it should be used. Today, vasopressin is not listed in the cardiac arrest algorithm at all because it has not been shown to be helpful. In fact, the AHA guidelines now stress that epinephrine should be given as early as possible for the best and strongest impact. Epinephrine ensures that the most possible blood gets to the heart muscle. It also improves blood pressure.
ETCO2
A lesser-known and less talked about change to the guidelines involves end tidal CO2 levels. This is a new recommended measurement to show what the chance of survival is for intubated patients who are coding. To achieve the best survival rates, ETCO2 should be at 10 mm Hg or higher after 20 minutes of resuscitation This new measurement can take some of the pressure off providers to determine when the code should be terminated. However, this is not the only measurement that should be relied on to determine when termination should occur because studies of it have not be large to date.
Post-Cardiac Arrest Drugs
ACLS guidelines also recommend drugs that should be given once the code is completed and the patient is resuscitated. Lidocaine and beta blockers used to be routinely given to certain patients after resuscitation. While current guidelines state that there’s not enough evidence to show that this is a good practice, you may still need to consider these drugs for some patients, such as those whose arrest was caused by V-fib or V-tach. However, you must be careful with beta blockers because they can lower the blood pressure dramatically.
Chest Compressions
Guidelines now state that chest compressions should be done at 100 to 120 per minute rather than at a minimum of 100. They also recommend that compressions be five to six centimeters deep and that you should decrease pressure enough between compressions to allow the chest to recoil fully.
By being aware of these changes to the guidelines, you can not only pass your ACLS certification examination more confidently but also can rest assured that you are giving the best possible care to your patients.