Adult advanced life support
1. The guideline process
2. Summary of changes in advanced life support since 2010 Guidelines
3. Introduction
4. ALS treatment algorithm
5. Treat reversible causes
6. During CPR
7. CPR techniques and devices
8. Duration of resuscitation attempt
9. Acknowledgements
10. References
Authors
Jasmeet Soar, Charles Deakin, Andrew Lockey, Jerry Nolan, Gavin Perkins
1. The guideline process
The process used to produce the Resuscitation Council (UK) Guidelines 2015 has been accredited by the National Institute for Health and Care
Excellence. The guidelines process includes:
Systematic reviews with grading of the quality of evidence and strength of recommendations. This led to the 2015 International Liaison
Committee on Resuscitation (ILCOR) Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with
Treatment Recommendations.1,2
The involvement of stakeholders from around the world including members of the public and cardiac arrest survivors.
Details of the guidelines development process can be found in the Resuscitation Council (UK) Guidelines Development Process Manual.
www.resus.org.uk/publications/guidelines-development-process-manual/
These Resuscitation Council (UK) Guidelines have been peer reviewed by the Executive Committee of the Resuscitation Council (UK), which
comprises 25 individuals and includes lay representation and representation of the key stakeholder groups.
2. Summary of changes in advanced life support since 2010 Guidelines
The 2015 Advanced life support (ALS) guidelines have a change in emphasis aimed at improved care and implementation of these guidelines in
order to improve patient outcomes.3 The key changes since 2010 are:
Increased emphasis on minimally interrupted high quality chest compressions throughout any ALS intervention.
Chest compressions must only be paused briefly to enable specific interventions. This includes minimising interruptions in chest
compressions to less than 5 seconds when attempting defibrillation or tracheal intubation.
There is a new section on monitoring during ALS.
Waveform capnography must be used to confirm and continually monitor tracheal tube placement, and may be used to monitor the quality
of CPR and to provide an early indication of return of spontaneous circulation (ROSC).
There are a variety of approaches to airway management during CPR and a stepwise approach based on patient factors and the skills of the
rescuer is recommended.
The recommendations for drug therapy during CPR have not changed, but there is equipoise for the role of drugs in improving outcomes
from cardiac arrest.
The routine use of mechanical chest compression devices is not recommended, but they may be useful in situations where sustained high
quality manual chest compressions are impractical or compromise provider safety.
Peri-arrest ultrasound may be used to identify reversible causes of cardiac arrest.
Extracorporeal life support techniques may be used as a rescue therapy in selected patients where standard ALS measures are not
successful.
The ALS algorithm (Figure 1) has been modified slightly to show these changes.
, Figure 1. Adult advanced life support algorithm
A4-size algorithm: http://resus.org.uk/_resources/assets/attachment/full/0/6442.pdf
3. Introduction
This section on adult advanced life support (ALS) adheres to the same general principles as Guidelines 2010, but incorporates some important
changes. The guidelines in this section apply to healthcare professionals trained in ALS techniques. Laypeople, first responders, and automated
external defibrillator (AED) users are referred to the Adult basic life support and automated external defibrillation section.
www.resus.org.uk/resuscitation-guidelines/adult-basic-life-support-and-automated-external-defibrillation/
Adult ALS includes advanced interventions after basic life support has started and when appropriate an AED has been used. The transition
between basic and advanced life support should be seamless as BLS will continue during and overlap with ALS interventions. Post-resuscitation
care guidelines are presented in a new section that recognises the importance of the final link in the Chain of Survival.4
www.resus.org.uk/resuscitation-guidelines/post-resuscitation-care/
These guidelines are based on the International Liaison Committee on Resuscitation (ILCOR) 2015 Consensus on Science and Treatment
Recommendations (CoSTR) for ALS2 and the European Resuscitation Council 2015 Advanced Life Support Guidelines.5 These contain all the
reference material for this section.
4. ALS treatment algorithm
Heart rhythms associated with cardiac arrest are divided into two groups: shockable rhythms (ventricular fibrillation/pulseless ventricular
tachycardia (VF/pVT)) and non-shockable rhythms (asystole and pulseless electrical activity (PEA)). The main difference in the treatment of these
two groups is the need for attempted defibrillation in patients with VF/pVT.
Other actions, including chest compression, airway management and ventilation, vascular access, administration of adrenaline, and the
identification and correction of reversible factors, are common to both groups. The ALS algorithm provides a standardised approach to the
management of adult patients in cardiac arrest.
Drugs and advanced airways are still included among ALS interventions, but are of secondary importance to early defibrillation and high quality,
1. The guideline process
2. Summary of changes in advanced life support since 2010 Guidelines
3. Introduction
4. ALS treatment algorithm
5. Treat reversible causes
6. During CPR
7. CPR techniques and devices
8. Duration of resuscitation attempt
9. Acknowledgements
10. References
Authors
Jasmeet Soar, Charles Deakin, Andrew Lockey, Jerry Nolan, Gavin Perkins
1. The guideline process
The process used to produce the Resuscitation Council (UK) Guidelines 2015 has been accredited by the National Institute for Health and Care
Excellence. The guidelines process includes:
Systematic reviews with grading of the quality of evidence and strength of recommendations. This led to the 2015 International Liaison
Committee on Resuscitation (ILCOR) Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with
Treatment Recommendations.1,2
The involvement of stakeholders from around the world including members of the public and cardiac arrest survivors.
Details of the guidelines development process can be found in the Resuscitation Council (UK) Guidelines Development Process Manual.
www.resus.org.uk/publications/guidelines-development-process-manual/
These Resuscitation Council (UK) Guidelines have been peer reviewed by the Executive Committee of the Resuscitation Council (UK), which
comprises 25 individuals and includes lay representation and representation of the key stakeholder groups.
2. Summary of changes in advanced life support since 2010 Guidelines
The 2015 Advanced life support (ALS) guidelines have a change in emphasis aimed at improved care and implementation of these guidelines in
order to improve patient outcomes.3 The key changes since 2010 are:
Increased emphasis on minimally interrupted high quality chest compressions throughout any ALS intervention.
Chest compressions must only be paused briefly to enable specific interventions. This includes minimising interruptions in chest
compressions to less than 5 seconds when attempting defibrillation or tracheal intubation.
There is a new section on monitoring during ALS.
Waveform capnography must be used to confirm and continually monitor tracheal tube placement, and may be used to monitor the quality
of CPR and to provide an early indication of return of spontaneous circulation (ROSC).
There are a variety of approaches to airway management during CPR and a stepwise approach based on patient factors and the skills of the
rescuer is recommended.
The recommendations for drug therapy during CPR have not changed, but there is equipoise for the role of drugs in improving outcomes
from cardiac arrest.
The routine use of mechanical chest compression devices is not recommended, but they may be useful in situations where sustained high
quality manual chest compressions are impractical or compromise provider safety.
Peri-arrest ultrasound may be used to identify reversible causes of cardiac arrest.
Extracorporeal life support techniques may be used as a rescue therapy in selected patients where standard ALS measures are not
successful.
The ALS algorithm (Figure 1) has been modified slightly to show these changes.
, Figure 1. Adult advanced life support algorithm
A4-size algorithm: http://resus.org.uk/_resources/assets/attachment/full/0/6442.pdf
3. Introduction
This section on adult advanced life support (ALS) adheres to the same general principles as Guidelines 2010, but incorporates some important
changes. The guidelines in this section apply to healthcare professionals trained in ALS techniques. Laypeople, first responders, and automated
external defibrillator (AED) users are referred to the Adult basic life support and automated external defibrillation section.
www.resus.org.uk/resuscitation-guidelines/adult-basic-life-support-and-automated-external-defibrillation/
Adult ALS includes advanced interventions after basic life support has started and when appropriate an AED has been used. The transition
between basic and advanced life support should be seamless as BLS will continue during and overlap with ALS interventions. Post-resuscitation
care guidelines are presented in a new section that recognises the importance of the final link in the Chain of Survival.4
www.resus.org.uk/resuscitation-guidelines/post-resuscitation-care/
These guidelines are based on the International Liaison Committee on Resuscitation (ILCOR) 2015 Consensus on Science and Treatment
Recommendations (CoSTR) for ALS2 and the European Resuscitation Council 2015 Advanced Life Support Guidelines.5 These contain all the
reference material for this section.
4. ALS treatment algorithm
Heart rhythms associated with cardiac arrest are divided into two groups: shockable rhythms (ventricular fibrillation/pulseless ventricular
tachycardia (VF/pVT)) and non-shockable rhythms (asystole and pulseless electrical activity (PEA)). The main difference in the treatment of these
two groups is the need for attempted defibrillation in patients with VF/pVT.
Other actions, including chest compression, airway management and ventilation, vascular access, administration of adrenaline, and the
identification and correction of reversible factors, are common to both groups. The ALS algorithm provides a standardised approach to the
management of adult patients in cardiac arrest.
Drugs and advanced airways are still included among ALS interventions, but are of secondary importance to early defibrillation and high quality,
