Why we are doing, what we are giving and what to be followed ?

1. ACLS
Dr Sumitha
Assistant Professor
Dept of Anaesthesia
Kidwai Cancer Institute
Bengaluru

2. ACLS- ADVANCED CARDIOVASCULAR LIFE SUPPORT

3. ACLS –ADVANCED CARDIOVASCULAR LIFE SUPPORT

4. Hospital & Out of hospital settings - many CARDIAC
ARREST – Do not receive HIGH QUALITY CPR
ACLS providers function as a TEAM that implement and
integrate both basic and advanced life support to save a
person life.

5. •AHA algorithm outlines all assessment & management
steps for a pulseless patient who does not respond to
BLS intervention ( including first shock with AED)

6. • ACLS consists of a TEAM LEADER who integrates HIGH
QUALITY CPR with minimal interruptions with advanced life
support strategies including
 DEFIBRILLATION
 MEDICATIONS
 ADVANCED AIRWAY

7. CPR WITH MINIMAL INTERRUPTION
Pressure gradient which drives Coronary blood flow
 CPP = Aortic diastolic pressure- Right Atrial Diastolic pressure
[ It correlates with ROSC]
WHY IS IT SO IMPORTANT ?

8. CORONARY PERFUSION PRESSURE
• Effectiveness of CPR – depends on CPP maintained (minimum of 10
mmHg)
• It takes several compression to raise CPP to a level that perfuse the heart
• Higher the CPP higher the ROSC.

10. CORONARY PERFUSION PRESSURE

12. VF/ pVT
PEA/ Asystole

13. VF- Ventricular fibrillation
pVT- Pulseless Ventricular tachycardia
PEA- Pulseless electrical activity
Asystole

14. PULSELESS VENTRICULAR TACHYCARDIA
 Fast but regular rhythm
 Too rapid to sustain
adequate cardiac output

15. VENTRICULAR FIBRILLATION
 Rapid & irregular cardiac activity
 Inability to contact as a whole

16. VENTRICULAR FIBRILLATION

17. VENTRICULAR FIBRILLATION

18. VENTRICULAR FIBRILLATION

19. PEA – PULSELESS ELECTRICAL ACTIVITY
• Heterogenous group of rhythms that are organised or semi organised but
lack a palpable pulse. { Electromechanical dissociation}
 Idioventricular rhythms
 Ventricular escape rhythms
 Post defrillation idioventricular rhythms
 Sinus rhythms

20. PEA- PULSELESS ELECTRICAL ACTIVITY

21. ASYSTOLE
• Cardiac arrest rhythm associated with no detectable electrical activity on
ECG / flat line.
• Rule out – Loose leads
No power
Signal gain too low
Fine VF / any rhythm masquerading as a flat line

22. ASYSTOLE

23. DEFIBRILLATOR

24. DEFIBRILLATOR
• Do not restart the heart
• Stuns the heart & terminates all electrical activity [ VF/pVT]

25. DEFIBRILLATION

26. DEFIBRILLATION- VIDEO

27. DRUGS

28. EPINEPHRINE / ADRENALINE
• 1mg iv /IO
• 20ml bolus IV fluid
• Elevate extremity
• Increases coronary &
Cerebral Blood flow

29. AMIODARONE
• Antiarrhymics
• 300mgIV bolus
followed by 150 mg if VF/pulselessVT persist
( if not available –Lidocaine 1-1.5mg/kg,
0.5-.75mg/kg IV/IO)

30. ROUTES OF ADMINISTRATION OF DRUGS
• Intravenous route- peripheral IV is preferred for drug & fluid
administration
• Intra osseous route- if IV not available
• Endotracheal route- dose to be give 2- 2.5 times the IV route

31. CONTINUOUS WAVEFORM CAPNOGRAPHY IS RECOMMENDED IN
ADDITION TO CLINICAL ASSESSMENT AS THE MOST RELIABLE METHOD
OF CONFIRMING AND MONITORING CORRECT PLACEMENT OF AN ETT
ETCO2

33. • “ FOR EVERY MINUTE THAT PASSES BETWEEN COLLAPSE & DEFIBRILLATION
• CHANCE OF SURVIVAL DECREASES 7-10% PER MINUTE IF CPR NOT GIVEN

34. TEAM WORK

35. • DIFFERENT ROLES
AIRWAY
DEFIBRILLATOR
RECORDER
DRUGS
CPR

36. Shockable rhythm- Left side of Algorithm chart
Non shockable rhythm - Right side of Algorithm chart

41. THANK YOU