Advanced life support

Advanced life support (ALS) is a set of life-saving protocols and skills that extend basic life support (BLS) to further support the circulation and provide an open airway and adequate ventilation (breathing).

Key aspects of ALS level care include:

In cases of cardiac arrest, ALS builds on the foundations of basic life support (BLS) interventions such as bag-mask ventilation with high-flow oxygen, chest compressions, and use of an AED.

The core algorithm of ALS that is invoked when cardiac arrest has been confirmed, Advanced Cardiac Life Support (ACLS), relies on the monitoring of the electrical activity of the heart on a cardiac monitor. Depending on the type of cardiac arrhythmia, defibrillation and/or medication may be administered. Oxygen is administered and endotracheal intubation may be attempted to secure the airway. At regular intervals, the effectiveness of the interventions on the heart rhythm, as well as the presence of cardiac output, is assessed.

Medications that may be administered include adrenaline (epinephrine), amiodarone, atropine, bicarbonate, calcium, potassium and magnesium, among others. Saline or colloids may be administered to increase the circulating volume.

While CPR is performed (which may involve either manual chest compressions or the use of automated equipment such as the AutoPulse or LUCAS device), members of the team consider eight forms of potentially reversible causes for cardiac arrest, commonly abbreviated as “6Hs & 5Ts” according to 2005/2010 AHA Advanced Cardiac Life Support (ACLS). Note these reversible causes are usually taught and remembered as 4Hs and 4Ts—including hypoglycaemia and acidosis with hyper/hypokalaemia and 'metabolic causes' and omitting trauma from the T's as this is redundant with hypovolaemia—this simplification aids recall during resuscitation.

As of December 2005, advanced cardiac life support guidelines have changed significantly. A major new worldwide consensus has been sought based upon the best available scientific evidence. The ratio of compressions to ventilations is now recommended as 30:2 for adults, to produce higher coronary and cerebral perfusion pressures. Defibrillation is now administered as a single shock, each followed immediately by two minutes of CPR before rhythm is re-assessed (five cycles of CPR).

ALS also covers various conditions related to cardiac arrest, such as cardiac arrhythmias (atrial fibrillation, ventricular tachycardia), poisoning and effectively all conditions that may lead to cardiac arrest if untreated, apart from the truly surgical emergencies (which are covered by Advanced Trauma Life Support).