Analysis of the AHA Year 2000 ACLS Guidelines

Sample EMS Protocols

Comments

In these protocols, vasopressin has been inserted as the initial drug to administer in cardiac arrest; current AHA guidelines recommend it’s use in ventricular fibrillation/pulseless ventricular tachycardia, and though not in algorithms, ACLS text offers consideration of it in PEA and asystole. Literature/studies published since the ACLS guidelines came out show benefit in the use of vasopressin in hypovolemic-related cardiac arrest and in some animal studies of asystole. Given the current concern about epinephrine’s effect on intracardiac muscle perfusion and questions about it’s effect on cerebral tissue during cardiac arrest, vasopressin was inserted as the preferred agent to provide vasopressor effects to cardiac arrest patients in these protocols. Several small studies, comparing epinephrine, vaospressin and control groups predominately conclude that vasopressin provides the best outcome. Much more is expected to be learned about vasopressin as a major multi-center European trial continues and concludes in 2002. 

Amiodarone has replaced lidocaine as the preferred anti-arrhythmic in VF/pulseless VT. One study (ARREST), concluded that almost 29% more patients had return of pulses upon admission to the hospital than patients not given any dysrhythmic (placebo). It did not show any increase in overall patient survival (outcome). The authors state that this is the first sizeable study to show any improvement in cardiac arrest patient management by an antidysrhythmic. The question remains, will it lead to more cardiac arrest survivors?

There has been concern voiced over the accuracy of intubations (primarily, out-of-hospital), alternative devices (LMAs) and methods of confirming tube placement, so new guidelines have been put into place---please review the second-level ABCD reference that follows and the new ACLS Guidelines 2000.

Finally, there have been some significant basic changes in BCLS (rate of 100, not 80-100; ratios of 15 compressions to 2 ventilations for one and two rescuers, and nonstop compressions once the patient is intubated) that have been made. Please review and consider implementing these changes.

What to you think? E-mail us and we'll add to this discussion.

Sample Protocols
ACLS EMS* Quick Summary Overview

Universal Initial and Second-level "ABCD"

ACLS Drug Reference

Persistent VF and Pulseless VT

Asystole

PEA

Bradycardia

Tachycardia

*EMS: Does not include additional medications such as specific beta-blockers, digoxin, or other calcium channel blockers.
See previous protocols or use ECC handbook 2000 for further explanation, dosages, and reference.

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