Cardiopulmonary Resuscitation


2010 ACLS Guidelines

ACLS Algorithm


AHA 2010 guideline updates

Chain of Survival

Continued emphasis on high quality CRP with minimal interruptions

  • Change sequence from "ABC" to "CAB"
    • Chest compressions first then ventilations after first cycle
  • "Look, listen, Feel" removed from the algorithm
  • Pulse checks de-emphasised
  • No difference between witnessed and unwitnessed arrest protocols
  • Non-trained bystanders should provide "Hands-only" CPR
  • Compression rate at least 100/minute
  • Compression depth of at least 5cm (adults)
Simplified BLS Algorithm
  • Complete chest recoil after each compression
  • Minimise interruptions in compressions
  • Avoid excessive ventilation
  • Emphasis on team approach with multiple simultaneous interventions

Electrical therapy

  • Lay people encouraged to use an AED, even without training
  • Initial biphasic shock for AF is 150J
  • Adults with stable monomorphic VT - trial synchronised 100J

ACLS

  • Routine cricoid pressure not recommended
  • Use continuous capnography if intubated
  • Emphasis on high quality CPR
  • Atropine no longer used in PEA/Asystole
  • Adenosine is recommended in stable, undifferentiated, regular monomorphic wide complex tachycardia
  • Trial of chronotropic drugs before pacing suggested for unstable bradycardia

Post cardiac arrest

  • Therapeutic hypothermia and percutaneous coronary interventions encouraged
  • Pos arrest O2 titrated to keep SaO2 >94%

Further notes

  • Vasopressin and Adrenaline are equally efficacious after cardiac arrest [BestBets].
  • Biphasic defibrillation is best treatment [ Level 2 evidence] for adult VF and should be used when available [BestBets].


Content by Dr Íomhar O' Sullivan 12/11/2001. Reviewed by Dr ÍOS 10/09/2003, 19/07/2005. Last review Dr ÍOS 5/05/15