AHA 2005

ACLS Guidelines

Increased Emphasis On:

Effective CPR– “Push hard and push fast”– Chest compressions

Airway- New

5 cycles of CPR/ 2 min prior to phoning 911 for infants/children

No jaw thrust (lay people) Health care providers may use head-

chin tilt in injured patients if jaw thrust fails

Airway- Old

1 min of CPR prior to phoning 911 for infants/children

Jaw thrust only for injured patients (both health care providers and lay people)

Breathing

ALL rescue breaths over 1 s, with adequate volume to produce visible chest rise

Lay people: check for normal breathing in adults

Normal (not deep) breath prior to AR Continuous cycles when intubated only 8-10 resps per min when intubated (q 6-8 s) No rescue breathing without compressions for

lay people

Breathing- Old

Rescue breaths over 1-2 s Varying tidal volumes suggested 10-12 resps/min once intubated

Circulation- New

Single compression to ventilation ratio for ALL single rescuers for ALL victims (excluding newborns)– 30:2 (100/min)– 5 cycles (2 min) CPR in between rhythm

checks– Health care providers (2 rescuer):

• Adults 30:2• Infants/children 15:2

Circulation- New

Limit interruptions in compressions Rescuers may use one or two hands for

child CPR Unwitnessed arrests: may consider 5

cycles of CPR prior to defibrillation (or response time > 4 min)

Circulation- Old

Minimizations in interruptions not emphasized

Adult: 15:2 Infant and child: 5:1 Rhythm and pulse checks after

defibrillation

Defibrillation- New

Single shocks followed by immediate CPR for VF/ pulseless VT– 360 J for monophasic defibrillators– Biphasic defibrillators: device dependent (120-

200 J)

No rhythm/pulse check prior to initial 5 cycles, then pulse check only if organized rhythm present

Rhythm checks every 5 cycles (2 min)

Defibrillation- Old

3 stacked shocks for initial defibrillation– 200 J, 300 J, 360 J

Single shock for subsequent defibrillations– 360 J

Adjuncts

AED’s– Use of AED’s in children 1-8 years old (use

pediatric system if available)– New AED’s will prompt rescuers for reassessment– Single shocks without rhythm check following– Use as soon as available except out of-hospital

HC provider with child (not sudden arrest) or adult (unwitnessed arrest)

• 5 cycles CPR prior

Adjuncts

Airway:– LMA/Combitubes

Pacing:– No longer used in asystolic arrest

Algorithms

Polymorphic VT– Unsynchronized (defibrillation) shocks

Bradycardia– Atropine dose 0.5 mg

Arrest– Drugs timed to be delivered with CPR ASAP after

rhythm check VF/ pulseless VT

– Antiarrhythmics: Amiodarone preferred, then lidocaine

Algorithms

Tachycardia– Simplified to one algorithm– Wide vs narrow complex; irreg vs reg– Simplified suggested drugs