Acls/bls Changes

BLS/ACLS Changes

In October 2010, the American Heart Association released their new guidelines for Basic Life Support (BLS) and Advanced Care Life Support (ACLS). Every five years, the American Heart Association evaluates its current guidelines with research and reviews to determine if changes need to be made to improve the effectiveness of lifesaving procedures. Major changes were made to the BLS guidelines while minor changes were made to ACLS guidelines.

Changes in BLS

The most profound change to the 2010 American Heart Association (AHA) guidelines is in the sequence of BLS steps. In previous AHA guidelines, the sequential steps were airway, breathing, and circulation. In the 2010 AHA guidelines, the steps have changed to chest compressions, airway, and breathing for both adult and pediatric patients. The emphasis is on quickly starting chest compressions so that blood flow is maintained. The rationale for this change is that the majority of cardiac arrests occur in adults and the survival rates are higher among witnessed cardiac arrests with a rhythm of vfib or pulseless vtach. The most important element of CPR in these patients was chest compressions and early defibrillation.

Another change is in the depth of the chest compressions. Previous AHA guidelines recommended that chest compressions depress the adult sternum 1.5 to 2 inches at a rate of 100 compressions per minute. According to the 2010 AHA guidelines, chest compressions should depress the adult sternum at least 2 inches with a rate of at least 100 compressions per minute. Complete recoil of the chest is required.

Changes in ACLS

The AHA has recommended four new medication protocols for 2010 guidelines. Atropine is no longer recommended in the treatment of PEA and asystole. The rationale is that there is no evidence to prove that it has any therapeutic benefits. Adenosine is recommended in the treatment of stable, wide-complex tachycardia when the rhythm is regular. As an alternative to external pacing for patients with unstable or symptomatic bradycardia, intravenous chronotropic agents are recommended. Lastly, oxygen supplementation in patients complaining of chest pain is no longer indicated unless the patient's oxygen saturation is less than or equal to 94%.

A new chapter was created in the 2010 guidelines titled post cardiac arrest care. Emphasis is placed on structured care of the post cardiac arrest patient. Therapeutic hypothermia and percutaneous coronary interventions should be used when indicated post cardiac arrest. New stroke care recommendations are also emphasized. Pre-hospital treatment of hypertension in the stroke patient de-emphasized. The time window for the use of TPA remains at 3 hours from onset of symptoms, however in selected patients it can be extended to 4.5 hours from symptom onset.