Evidence-based guideline for cardiac arrest algorithms, defibrillation, ACLS medications, arrhythmia management, special circumstances, and post-arrest care.
A comprehensive, evidence-based clinical guideline for advanced cardiac life support (ACLS) and the management of cardiac arrest in adults. This resource synthesizes recommendations from the major international resuscitation science organizations, emergency cardiovascular care committees, and landmark clinical trials into a single integrated reference for emergency physicians, intensivists, cardiologists, anesthesiologists, and all clinicians who participate in resuscitation.1 2 3 4 5 6 7
Cardiac arrest remains a leading cause of death worldwide, affecting an estimated 350,000–400,000 adults annually in out-of-hospital settings in the United States alone, with an additional 290,000 in-hospital cardiac arrests each year. Despite decades of research and guideline development, survival from out-of-hospital cardiac arrest (OHCA) remains between 8% and 12%, with in-hospital cardiac arrest (IHCA) faring somewhat better at 25–35%. The chain of survival — early recognition, early high-quality CPR, early defibrillation, advanced resuscitation, and integrated post-arrest care — represents the evidence-based framework through which outcomes can be maximized. This guideline covers every link in that chain, from the foundational principles of high-quality cardiopulmonary resuscitation through cardiac arrest algorithms, pharmacotherapy, airway management, arrhythmia management, special circumstances, extracorporeal resuscitation, and the criteria for termination of efforts.
Contents:
| Part | Title | Coverage |
|---|---|---|
| Part 1 | BLS Foundation, High-Quality CPR & Defibrillation | Chain of survival; high-quality CPR (rate, depth, recoil, fraction); compression-only CPR; automated external defibrillation; manual defibrillation energy levels; pad placement strategies; waveform capnography for CPR quality; refractory VF strategies (double sequential defibrillation, vector change, esmolol) |
| Part 2 | Cardiac Arrest Algorithms & ACLS Pharmacotherapy | VF/pVT algorithm; asystole/PEA algorithm; H’s and T’s reversible causes; epinephrine (dose, timing, PARAMEDIC2 evidence); amiodarone; lidocaine; vasopressin; sodium bicarbonate; calcium; magnesium; lipid emulsion; advanced airway management during arrest; ventilation strategies |
| Part 3 | Tachyarrhythmia & Bradyarrhythmia Management | Narrow complex regular tachycardia (SVT, adenosine); narrow complex irregular (atrial fibrillation/flutter); wide complex regular tachycardia; wide complex irregular tachycardia; synchronized cardioversion energy levels; unstable vs stable algorithm; bradyarrhythmia algorithm; atropine; transcutaneous pacing; dopamine and epinephrine infusions; transvenous pacing indications |
| Part 4 | Special Circumstances in Cardiac Arrest | Pregnancy (perimortem cesarean delivery); drowning; hypothermia; pulmonary embolism (thrombolysis during CPR); tension pneumothorax; cardiac tamponade; opioid overdose; hyperkalemia; anaphylaxis; toxic ingestions (sodium channel blockers, calcium channel blockers, beta-blockers, digoxin); local anesthetic systemic toxicity (LAST); electrolyte emergencies |
| Part 5 | ECPR, CPR Quality Metrics, Pediatric Considerations & Termination of Resuscitation | Extracorporeal CPR (ECPR) indications, contraindications, and evidence (ARREST trial); CPR quality metrics (compression fraction, ETCO2, coronary perfusion pressure, diastolic blood pressure); pediatric cardiac arrest differences (weight-based dosing, energy levels); neonatal considerations; termination of resuscitation criteria (BLS and ALS rules); post-arrest care cross-reference |
Panchal AR, Bartos JA, Cabanas JG, et al. “Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.” Circulation. 2020;142(16_suppl_2):S366-S468. DOI: 10.1161/CIR.0000000000000916 ↩︎
Soar J, Bottiger BW, Carli P, et al. “European Resuscitation Council Guidelines 2021: Adult Advanced Life Support.” Resuscitation. 2021;161:115-151. DOI: 10.1016/j.resuscitation.2021.02.010 ↩︎
Berg KM, Soar J, Andersen LW, et al. “Adult Advanced Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.” Circulation. 2020;142(16_suppl_1):S92-S139. DOI: 10.1161/CIR.0000000000000893 ↩︎
Merchant RM, Topjian AA, Panchal AR, et al. “Part 1: Executive Summary: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.” Circulation. 2020;142(16_suppl_2):S337-S357. DOI: 10.1161/CIR.0000000000000918 ↩︎
Perkins GD, Graesner JT, Semeraro F, et al. “European Resuscitation Council Guidelines 2021: Executive Summary.” Resuscitation. 2021;161:1-60. DOI: 10.1016/j.resuscitation.2021.02.003 ↩︎
Berg KM, Grossestreuer AV, Engel D, et al. “2023 American Heart Association Focused Update on the Management of Cardiac Arrest and Post–Cardiac Arrest Care.” Circulation. 2024;149(5):e254-e273. DOI: 10.1161/CIR.0000000000001186 ↩︎
Olasveengen TM, Mancini ME, Perkins GD, et al. “Adult Basic Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.” Circulation. 2020;142(16_suppl_1):S41-S91. DOI: 10.1161/CIR.0000000000000892 ↩︎
Extracorporeal CPR indications and evidence, CPR quality metrics and physiologic targets, pediatric cardiac arrest differences with weight-based dosing, neonatal resuscitation overview, termination of resuscitation criteria, and post-arrest care cross-reference.
Cardiac arrest management in pregnancy, drowning, hypothermia, pulmonary embolism, tension pneumothorax, cardiac tamponade, opioid overdose, hyperkalemia, anaphylaxis, and toxicologic emergencies.
Narrow and wide complex tachycardia algorithms, synchronized cardioversion energy levels, SVT management with adenosine, atrial fibrillation rate and rhythm control, bradycardia algorithm, atropine, transcutaneous pacing, and vasopressor infusions.
VF/pVT and asystole/PEA algorithms, H's and T's reversible causes, epinephrine, amiodarone, lidocaine, sodium bicarbonate, calcium, magnesium, lipid emulsion, and advanced airway management during arrest.
Chain of survival, high-quality CPR parameters, compression-only CPR, AED use, manual defibrillation energy levels, pad placement, waveform capnography, and refractory VF strategies.