The New 2010 guidelines for ACLS(Advanced cardiac life support)were change last October 2010 by American Heart Association. Every 5 years they evaluates the existing guidelines base upon the data collected within previous 5 years to determine if changes need to be made to improve the effectiveness of lifesaving procedure. Therefore the New 2010 ACLS guidelines are also the guideline for the next 4 years .
Below is just few of the many changes in the updated ACLS Guidelines, For entire set of guidelines you may visit Circulation’s Journals.
New Guidelines of ACLS (Advanced cardiac life support) 2010
A-B-C to C-A-D
The ABCs alphabet that a lot of nurses know has changed to CAB- as in Circulation first then Airway then Breathing ratio is still 30:2 compressions:breaths. Although ventilations are an important part of resuscitation, evidence shows that compressions are the critical element in adult resuscitation. Compressions are often delayed while providers open the airway and deliver breaths. If a pulse is not detected within 10 seconds, do start compressions without further delay.
Chest compression changes
The new changes to chest compression required that
- Depress the adult sternum at least 2 inches, rather than the previous recommendation of 1 ½ to 2 inches deeper compressions are required to generate the pressures necessary to perfuse the coronary and cerebral arteries.
- Compressions should be performed at a rate of at least 100/minute each set of 30 compressions should take approximately 18 seconds or less.
- Interval between stopping chest compression and shock delivery should be encouraged. By minimizing the pause between compressions and shock improves the chances of shock success
- Checking for a pulse in an unresponsive individual now requires less than 10 seconds chest compressions aren’t delayed.
- Lastly, mistakenly doing chest compression on someone with a pulse does little harm compared to not doing compressions on someone without a pulse.
The four most important points of changes in electrical therapy
- Minimize the interval between stopping compressions and delivering shocks .CPR should resume immediately after the shock delivery.
- Chest compressions should continue while the defibrillator is charging. Prior to delivering a shock, team leader is responsible for the safety of team members
- Patients in asystolic cardiac arrest is not recommended for Pacing
- In both defibrillation and cardioversion if the initial shock fails, providers should increase the dose in gradual.
The four new ACLS (Advanced cardiac life support) medication protocols recomended
- Atropine is no longer recommended for routine use in the management of pulseless electrical activity (PEA) or asystole, due to a lack of any observed therapeutic benefit.
- Adenosine is recommended for the treatment of stable, undifferentiated wide-complex tachycardia when the rhythm is regular and the QRS waveform is monomorphic.
- Intravenous chronotropic agents are recommended as an effective alternative to external pacing for individuals with symptomatic or unstable bradycardia.
- Oxygen supplementation for uncomplicated acute coronary syndromes is no longer routinely indicated and should only be applied if the oxyhemoglobin saturation is less than or equal to 94 percent.