ACLS: Advanced Cardiac Life Support

ACLS or advanced cardiac life support is a set of medical interventions used for the treatment of a number of critical medical emergencies, mainly that of cardiac arrest. This medical term can also refer to the actual skills and knowledge of individuals who are able to deploy the said interventions.

In order to master ACLS, both meticulous hands-on training and wide-ranging medical knowledge are required. Among other things, ACLS procedures require individuals to have the ability to comprehend emergency pharmacology, examine and provide an interpretation of available electrocardiograms, set up IV access, as well as deal with any problems in the airway of the patient. Therefore, not everyone is qualified to administer ACLS. Only licensed health care professionals such as clinical pharmacists, respiratory therapists, nurses, paramedics, and physicians are allowed to provide ACLS.

In some instances of cardiac arrest, immediate BLS or basic life support may be needed by the patient. This includes but is not limited to CPR or cardiopulmonary resuscitation. When it is required by the circumstances, BLS may be performed by nearly all types of health providers (even those not mentioned above).

The Actual Procedures of ACLS

As a medical procedure(s) ACLS is basically an extension of Basic Life Support or BLS. One of the main differences between the two is that BLS makes use of an AED or an Automated Extended Defibrillator to analyze the heart rhythm of the patients. In ACLS, it is the team leader who is tasked to do this manually and it is he who decides how and at what point the patient’s heart is to be shocked. The team leader has to base his decision on a few factors pertaining to the vital signs of the patient.

After the decision has been made, the next steps involve the insertion of IV or intravenous lines followed by the placement of the different airway devices. It is usually at this point when commonly used drugs in ACLS are administered. Atropine and epinephrine are two of the most popular drugs used in this process.

Following that, the advanced cardiac life support personnel now have to look for the possible reasons behind the patient’s cardiac arrest. Some of the more usual causes include trauma, drug overdose, and heart attack. It is only after a diagnosis is made when more specialized treatments are administered. Depending on the diagnosis made, there can be several approaches taken – it may either be surgical (e.g. chest tube is inserted for those affected by hemothoraces or pneumothoraces) or medical (e.g. drug OD antidote or an IV injection).

It is important to note that throughout the entire ACLS process, chest compression must continually be applied with minimal to no interruptions.

Ethical Issues Involved in ACLS

As with many other medical procedures, the administration of ACLS also entails a number of ethical issues. To begin with, there are some instances wherein the use of ACLS is legally prohibited. In other scenarios, there may be standing orders from someone like the EMS (Emergency Medical System) director particularly stating not to administer ACLS. Cases such as these make it very tough on the ACLS team as they practically have to watch the patient die before their eyes because of the fact that they are not allowed to perform the only option to save the patient’s life which is to apply ACLS.

These emotionally and ethically surrounded decisions are definitely easier to make when the medical records of the patients are readily available. This is especially true when there are explicit instructions on the records that state a DNR or “Do Not Resuscitate” order on the patient.

However, the moral dilemma is amplified in the field. A majority of EMS systems employ a standard set of rules for specific situations wherein the application of ACLS is deemed futile and should therefore no longer be administered. Instances that involve decomposition or decapitation in the patient are some examples of these said situations. However, it becomes very difficult to decide when the cases are border line.

It requires the health providers involved to make a judgment call on whether or not to apply ACLS and how it will affect the patient. Should they still administer the procedure knowing that if the patient survives, he’ll end up miserable the rest of his life (e.g. becomes a vegetable or loses vita body parts)? Or should they just “let the patient go” and not use ACLS? These are just some of the grueling ethical questions ACLS teams need to answer within a matter of a few seconds.

Another dilemma involved is when or at what point the use of advanced cardiac life support is to be terminated. There are some rules that provide advice regarding when to stop the administration of ACLS. As an example, one of these rules recommends that "termination of resuscitation when there was no return of spontaneous circulation prior to transport, no shock was given and the arrest was not witnessed by Emergency Medical Services personnel."