Master ACLS Algorithms 2025 - Updated AHA Guidelines
American Heart Association (AHA) updates the guidelines of CPR/ECC courses every 5 years. Below we review the 2020 updates. More can be found in 2020 AHA Guidelines.
The Advanced Cardiovascular Life Support (ACLS) algorithm is a systematic and evidence-based approach developed by the American Heart Association (AHA). It guides healthcare professionals in delivering emergency cardiac care for patients experiencing cardiac arrest, arrhythmias, strokes, and other life-threatening emergencies. The AHA revises the ACLS algorithm every five years to integrate the latest medical research and technological advancements, ensuring that treatment guidelines reflect the best practices for delivering high-quality cardiac care.
According to recent clinical research from the AHA, the ACLS algorithm provides a structured sequence of actions intended to stabilize patients in life-threatening conditions. This algorithm focuses on maximizing survival rates and ensuring optimal neurological outcomes. Mastery of these protocols is crucial for healthcare providers in emergency medicine, intensive care, and certain primary care settings, enabling rapid, organized, and effective intervention in high-pressure situations where every second matters.
The following are the core ACLS algorithms that are important for understanding and simplifying a patient's step-by-step treatment process. Familiarizing yourself with these flowcharts is crucial to passing your ACLS exam successfully. Your mastery of these ACLS protocols will undoubtedly help save many lives.
- ACLS Cardiac Arrest Algorithm
- ACLS Bradycardia Algorithm
- ACLS Tachycardia Algorithm
- ACLS Acute Coronary Syndrome (ACS)
- ACLS Suspected Stroke Algorithm
- ACLS Post-Cardiac Arrest Care Algorithm
- Cardiac Arrest in Pregnancy Algorithm
- Opioid-Associated Life-Threatening Emergency Algorithm.
All Advanced Cardiac Life Support Algorithms in 2020-2025
The adult cardiac arrest algorithm guides emergency treatment for sudden cardiac arrest. It's part of the Advanced Cardiovascular Life Support (ACLS) guidelines. This algorithm stresses quality CPR, quick defibrillation, and advanced care. First, confirm cardiac arrest. Then, start CPR and defibrillate if there's a shockable rhythm. The ACLS secondary assessment checks for shockable or non-shockable rhythms. Depending on the rhythm, give the right medications. Also, look for reversible causes, remembered as "H's and T's." Finish with post-arrest care. This approach aims to improve adult cardiac arrest and patient outcomes.
The Bradycardia Algorithm in Advanced Cardiovascular Life Support (ACLS) guides the management of adults with symptomatic bradycardia. Initially, healthcare providers should recognize the condition, typified by a heart rate under 60 bpm with symptoms like hypotension or altered mental status. Immediate interventions include 2nd° heart block type II and 3rd° heart block type. The algorithm's primary goal is to quickly address life-threatening symptoms linked to bradycardia.
The Tachycardia algorithms in ACLS guide treatment for rapid heart rhythms. Tachycardias are categorized as ventricular or supraventricular. For unstable tachycardia with symptoms like hypotension or altered mental status, immediate synchronized cardioversion is recommended. If pulseless, follow the VT or VF ACLS algorithms. For stable tachycardia, narrow complexes may indicate Supraventricular Tachycardia (SVT). Wide complexes suggest potential VT, with treatments like amiodarone considered. Addressing underlying causes (e.g., electrolyte imbalances) is vital. The Tachycardia algorithm's aim is to quickly manage life-threatening arrhythmias.
Acute Coronary Syndrome (ACS) algorithm in ACLS directs care for patients with acute coronary syndrome. Initially, it focuses on recognizing and assessing chest pain or discomfort and other ACS symptoms. Immediate steps include ensuring a patent airway, administering oxygen if needed, continuous ECG monitoring, and obtaining a 12-lead ECG to diagnose ST-segment elevation myocardial infarction (STEMI) or non-STEMI. Based on the ECG findings, the pathway splits: patients with STEMI might proceed to immediate reperfusion therapy, typically percutaneous coronary intervention (PCI). While non-STEMI patients are managed based on risk stratification. The Acute Coronary Syndrome algorithm’s primary aim is the identification and treatment of STEMI.
The Suspected Stroke Algorithm aims to quickly identify and manage potential stroke patients. It prioritizes timely assessment using tools like the FAST (Face, Arms, Speech, Time) exam. Crucially, a non-contrast CT scan is obtained to differentiate between ischemic and hemorrhagic stroke. This distinction guides treatment, with ischemic stroke candidates evaluated for clot-busting medications. Time is of the essence, as early intervention can significantly improve outcomes and reduce disability.
Post-cardiac arrest care algorithm is essential for optimal patient recovery. If someone collapses due to ventricular disturbances, immediate action with tools like an AED is crucial. Once resuscitated, the care continues by stabilizing the patient, regulating blood pressure, monitoring cardiac activity, and assessing neurological status. Targeted Temperature Management (TTM) can enhance neurological outcomes, while proper ventilation and hemodynamic stability ensure appropriate oxygenation and systemic perfusion. Modern post-cardiac arrest care, guided by the AHA's recommendations, integrates these aspects to offer patients the best chance of returning to their pre-arrest conditions.
The cardiac arrest in pregnancy is rare, occurring in only 1 in 30,000 pregnancies but carries a significantly higher mortality rate compared to the general population due to the physiological changes in a woman's body and the need to consider the life of both the mother and fetus. The resuscitation techniques for pregnant women are similar to those for other adults, but there are special considerations due to the dual-patient scenario. Thankfully, the ACLS In-Hospital Cardiac Arrest in Pregnancy Algorithm provides a structured, evidence-based approach to managing this critical emergency situation. By following standard ACLS protocols and algorithms, healthcare providers can ensure they are delivering the highest standard of care, improving outcomes in such emergencies where every second counts and informed actions can make all the difference.
Hs and Ts in ACLS Algorithm?
The below are the Hs and Ts in ACLS algorithm also known as reversible causes:
- Hypovolemia
- Hypoxia
- Hydrogen ion (acidosis)
- Hyper-/hypokalemia
- Hypoglycemia
- Hypothermia
- Toxins
- Tamponade(cardiac)
- Tension pneumothorax
- Thrombosis (coronary and pulmonary)
- Trauma
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AHA ACLS ALGORITHMS FAQS
Which alteration to the standard ACLS algorithm is appropriate for hypothermia?
During the extrication of a hypothermic cardiac patient to the hospital intermittent CPR is acceptable if continuous CPR is not possible. Withholding ACLS medical until the patient's body temperature reaches 30°C, it is reasonable to give 3 shocks and 3 doses of cardiac arrest medications after then.
What is the highest priority in Advanced Cardiac Life Support (ACLS) algorithm?
Intermittent CPR can be administered while transporting a hypothermic cardiac patient to the hospital if continuous CPR is not feasible. Delay the administration of ACLS (Advanced Cardiac Life Support) medications until the patient's body temperature reaches 30°C. Additionally, it may be reasonable to consider administering three shocks and three doses of cardiac arrest medications after the patient's body temperature has reached this level.
What are the ABCs of ACLS?
ABC refers to Airway, Breath, and Circulation. It's a common term used by healthcare providers to remember the initial assessment.
What are the 5 lethal rhythms?
Asystole, Ventricle Tachycardia (VT), Ventricle Fibrillation (VF), and Polymorphic Ventricle Tachycardia (Torsade de pointes) are the four lethal rhythms to recognize and review ECG interpretation.
What is the most important algorithm in ACLS?
Well, every algorithm is designed to simplify the recognition and treatment process for a patient having cardiac arrest yet the most important and commonly used algorithm is the cardiac arrest ACLS algorithm.
Owner Jeff Haughy has been providing high-quality care in the EMS industry since 1995 and started his Fire Service career with the Alameda Fire Department in 1991 as a Fire Explorer.