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Every five years, the American Heart Association evaluates available research and reviews existing first aid and life support guidelines. The goal? To determine if changes need to be made to improve the effectiveness of lifesaving procedures such as advanced cardiac life support (ACLS), pediatric advanced life support (PALS), basic life support (BLS) and cardiopulmonary resuscitation (CPR).

New ACLS guidelines were announced in late 2010, and Health Ed Solutions will reflect the new recommendations to ACLS and PALS courses by January 2011.

This is an overview of the updates to ACLS standards:

A-B-C to C-A-B
The A-B-C approach (Airway-Breathing-Circulation) has been changed to the C-A-B approach (Circulation-Airway-Breathing). The emphasis is on quickly initiating chest compressions in individuals with life-threatening loss of heart function so that blood flow is maintained. It primarily applies to CPR performed by a single rescuer. In the hospital setting and with teams, management of circulation and respirations are achieved simultaneously.

Chest compression changes
The chest compressions should depress the adult sternum at least 2 inches, rather than the previous recommendation of 1 ½ to 2 inches, and complete recoil of the chest is required. The chest compressions should be performed at a rate of at least 100 per minute, rather than the previous recommendation of about 100 per minute, to maximize critical blood flow. Checking for a pulse in an unresponsive individual should now require less than 10 seconds so that chest compressions aren't delayed. Mistakenly doing chest compressions on someone with a pulse does little harm compared to not doing compressions on someone without a pulse.

Quantitative Waveform Capnography recommendation
Use of quantitative waveform capnography is recommended for confirmation and monitoring of endotracheal tube placement. The continuous measurement provides the partial pressure of exhaled carbon dioxide in mm Hg over time. Individuals requiring endotracheal intubation are at risk of tube displacement during transport and transfer and the continuous waveform capnography reflects any changes. The capnography also provides a monitor of effective chest compressions. The return of spontaneous circulation is sometimes difficult to assess and is clearly demonstrated on the capnography measure by an abrupt increase in the CO2 readings.

New medication protocols
Four new medication protocols are recommended. One, atropine is no longer recommended for routine use in the management of pulseless electrical activity (PEA) or asystole, due to a lack of any observed therapeutic benefit. Two, adenosine is recommended for the treatment of stable, undifferentiated wide-complex tachycardia when the rhythm is regular and the QRS waveform is monomorphic. Three, intravenous chronotropic agents are recommended as an effective alternative to external pacing for individuals with symptomatic or unstable bradycardia. Finally, oxygen supplementation for uncomplicated acute coronary syndromes is no longer routinely indicated and should only be applied if the oxyhemoglobin saturation is less than or equal to 94 percent.

Emergency care priorities
To avoid interruptions to chest compressions or delays in use of defibrillators, the use of advanced airways, gaining vascular access and administering drugs doesn't take priority over high quality CPR and access to immediate defibrillation.

Post-cardiac arrest care 
A new section was created for Post-Cardiac Arrest Care, emphasizing a structured interdisciplinary system of care following a cardiac arrest. Therapeutic hypothermia treatment and percutaneous coronary interventions, such as coronary angiography with revascularization, should be provided when indicated after cardiac arrest.

New stroke care recommendations 
Stroke care through regional systems of care and organized stroke units are recommended. Prehospital treatment of blood pressure is de-emphasized, and the window of time for use of thrombolytics (rTPA) remains at within three hours of onset of stroke symptoms, but in selected patients can be extended to be within four and one-half hours after symptom onset. 

Previous ACLS study remains valid
If you've been trained under the old guidelines, you aren't required to immediately take a new course. The new ACLS guidelines don't suggest that the earlier guidelines were unsafe or ineffective, and individuals trained under earlier guidelines should continue to perform to these standards until they are trained under the new guidelines. Course completion cards will continue to be recognized as valid for two years, regardless of ACLS procedural changes.