Advanced cardiac life support: Difference between revisions
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imported>Howard C. Berkowitz (Study about futility of ACLS for out-of-hospital, non-trauma cardiac arrest) |
imported>Howard C. Berkowitz (citation error, but regarding futility of ACLS in non-trauma out-of-hospital arrest) |
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| Line 14: | Line 14: | ||
This can be much more difficult in the field. Most EMS systems have rules for the obvious cases when any life support would be futile, such as decapitation or decomposition. A current controversy deals with certain kinds of trauma, where, variously, | This can be much more difficult in the field. Most EMS systems have rules for the obvious cases when any life support would be futile, such as decapitation or decomposition. A current controversy deals with certain kinds of trauma, where, variously, | ||
#With reasonable medical certainty, there is no possibility of resuscitation with all possible resources. Finding a victim who is pulseless and has sustained major blunt chest trauma is the usual example where death is not obvious | #With reasonable medical certainty, there is no possibility of resuscitation with all possible resources. Finding a victim who is pulseless and has sustained major blunt chest trauma is the usual example where death is not obvious | ||
#Studies are ongoing about when ACLS is futile for out-of-hospital arrests.<ref name=>{{ | #Studies are ongoing about when ACLS is futile for out-of-hospital arrests.<ref name=Herlitz2004>{{citation | ||
| journal = Heart | | journal = Heart | ||
| date = 2004 October | | date = 2004 October | ||
| Line 22: | Line 22: | ||
| id=PMCID PMC1768510 | | id=PMCID PMC1768510 | ||
| title = Can we define patients with no chance of survival after out-of-hospital cardiac arrest? | | title = Can we define patients with no chance of survival after out-of-hospital cardiac arrest? | ||
| author = Herlitz J, Engdahl J, Svensson L, Young M, Ängquist K | | author = Herlitz J, Engdahl J, Svensson L, Young M, Ängquist K-A, Holmberg S | ||
|url = http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1768510}} pp. 1114–1118</ref> | |url = http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1768510}} pp. 1114–1118</ref> | ||
#Situations where ACLS will not help, but immediate surgical intervention has some chance. Current thinking is that the appropriate treatment for exsanguinating hemorrhage is not fluids, not ACLS, but immediately opening the chest for manual heart compression and, perhaps, emergency repair or control of a vascular injury. In such a situation, if there is minimal but not absent cardiac activity, and there is a facility nearby prepared for emergency thoracotomy, the ACLS "treat until stable" is less appropriate than "scoop and run". | #Situations where ACLS will not help, but immediate surgical intervention has some chance. Current thinking is that the appropriate treatment for exsanguinating hemorrhage is not fluids, not ACLS, but immediately opening the chest for manual heart compression and, perhaps, emergency repair or control of a vascular injury. In such a situation, if there is minimal but not absent cardiac activity, and there is a facility nearby prepared for emergency thoracotomy, the ACLS "treat until stable" is less appropriate than "scoop and run". | ||
Revision as of 13:41, 21 July 2008
In healthcare, Advanced cardiac life support is "the use of sophisticated methods and equipment to treat cardiopulmonary arrest. Advanced Cardiac Life Support (ACLS) includes the use of specialized equipment to maintain the airway, early defibrillation and pharmacological therapy."
Treatment
Clinical practice guidelines for advanced cardiovascular life support by the American Heart Association provide treatment algorithms:[1]
- Adult BLS Healthcare Provider Algorithm[2]
- Pulseless Arrest Algorithm[3]
- Bradycardia Algorithm.[4]
- ACLS Tachycardia Algorithm.[4]
Ethical issues
When not to start ACLS
In a particular jurisdiction, this may have legal constraints, or operational ones such as standing orders from the medical director of an emergency medical system (EMS). This kind of emotionally draining decision is apt to be most straightforward when a patien's medical records are readily available and contain an explicit "Do Not Resuscitate" (DNR) or "Do Not Attempt Resuscitation" request from the patient or a surrogate with the appropriate authority.
This can be much more difficult in the field. Most EMS systems have rules for the obvious cases when any life support would be futile, such as decapitation or decomposition. A current controversy deals with certain kinds of trauma, where, variously,
- With reasonable medical certainty, there is no possibility of resuscitation with all possible resources. Finding a victim who is pulseless and has sustained major blunt chest trauma is the usual example where death is not obvious
- Studies are ongoing about when ACLS is futile for out-of-hospital arrests.[5]
- Situations where ACLS will not help, but immediate surgical intervention has some chance. Current thinking is that the appropriate treatment for exsanguinating hemorrhage is not fluids, not ACLS, but immediately opening the chest for manual heart compression and, perhaps, emergency repair or control of a vascular injury. In such a situation, if there is minimal but not absent cardiac activity, and there is a facility nearby prepared for emergency thoracotomy, the ACLS "treat until stable" is less appropriate than "scoop and run".
When to terminate ACLS
References
- ↑ (December 2005) "2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation 112 (24 Suppl): IV1–203. DOI:10.1161/CIRCULATIONAHA.105.166550. PMID 16314375. Research Blogging.
- ↑ (December 2005) "2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: Part 4: Adult Basic Life Support". Circulation 112 (24 Suppl): IV1–203. DOI:10.1161/CIRCULATIONAHA.105.166550. PMID 16314375. Research Blogging.
- ↑ (December 2005) "2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: Part 7.2: Management of Cardiac Arrest". Circulation 112 (24 Suppl): IV1–203. DOI:10.1161/CIRCULATIONAHA.105.166550. PMID 16314375. Research Blogging.
- ↑ 4.0 4.1 (December 2005) "2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: Part 7.3: Management of Symptomatic Bradycardia and Tachycardia". Circulation 112 (24 Suppl): IV1–203. DOI:10.1161/CIRCULATIONAHA.105.166550. PMID 16314375. Research Blogging.
- ↑ Herlitz J, Engdahl J, Svensson L, Young M, Ängquist K-A, Holmberg S (2004 October), "Can we define patients with no chance of survival after out-of-hospital cardiac arrest?", Heart 90 (10), PMCID PMC1768510, DOI:10.1136/hrt.2003.029348. pp. 1114–1118