ACLS Updates Healthcare Professionals Need to Know

More than 700,000 people experience cardiac arrest each year across the United States, and without a healthcare workforce trained in advanced cardiac life support (ACLS), the total would undoubtedly be higher. However, these standards are by no means fixed—experts are constantly refining and adapting these guidelines based on science and real-world experience.

As these new standards roll out, healthcare professionals need to update their skill sets to provide the best possible care through ACLS certification and recertification. Today, these valuable credits can even be acquired online through high-quality educational resources. The American Heart Association (AHA) released its most recent update in 2023, offering fresh guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Here’s a summary of five important changes in recommendations by the AHA.

1. Post Cardiac Arrest Temperature Control

The 2020 ACLS guidelines recommended selecting and maintaining a constant temperature between 32°C and 36°C. This approach, referred to as Targeted Temperature Management (TTM), created a specific range of temperature maintenance integrated into many institutional therapeutic hypothermia protocols for adult post-resuscitation management.

The 2023 focused ACLS updates recommend selecting and maintaining a constant temperature between 32°C and 37.5°C during post-arrest temperature control. This offers a slightly broader temperature range, aligning more closely with normothermia.

Rationale

Recent research on the topic of TTM found no appreciable difference in primary outcomes related to survival or brain function at 6 months versus patients maintained at normothermia. This supports the revised recommendation that managing a constant temperature between 32°C and 37.5°C is a reasonable strategy. There is still more work to be done as it remains clear that the ideal temperature for special populations like those patients experiencing cardiac arrest secondary to noncardiac reasons remains unknown.

2. Post Arrest Cardiac Catheterization

The 2020 guidelines recommended emergent coronary angiography as a reasonable option for select adult patients who are comatose after cardiac arrest of suspected cardiac origin without ST elevation on their EKG.

The 2023 focused ACLS updates recommend that emergent coronary angiography is not recommended in patients with a return of spontaneous circulation after cardiac arrest unless they exhibit ST elevation myocardial infarction, shock, electrical instability, signs of significant myocardial damage, or ongoing ischemia.

Rationale

Following the publication of the 2020 ACLS guidelines, four randomized controlled trials (RCT) have been published that consistently found no evidence of improved outcomes for patients receiving emergent or early cardiac catheterization who did not present with ST elevations on their EKG.

These RCTs did not, however, include patients with ST-segment elevation, cardiogenic shock, signs of significant myocardial damage, electrical instability, and ongoing ischemia. Therefore, for patients with ST-segment elevations, high-risk acute coronary syndrome patients, and cardiogenic shock patients, it’s recommended to consider emergent cardiac catheterization.

3. Extracorporeal Cardiopulmonary Oxygenation (ECPR)

ECPR is a method of externally oxygenating the patient's blood while supporting their circulation. The 2020 guidelines suggested there was insufficient evidence to recommend the routine use of ECPR for patients with cardiac arrest.

The 2023 ACLS updates recommend the use of ECPR for patients with cardiac arrest refractory to standard ACLS as a reasonable option for select patients in the context of a care team with appropriately trained personnel and access to specialized equipment.

Rationale

Since the 2020 guidelines, two randomized controlled trials have been published on the subject. With each comparing patients with refractory cardiac arrest treated with ongoing standard ACLS versus ECPR, those cases using ECPR demonstrated improved survival to discharge and 6-month survival rates with neurologically favorable outcomes. A notable limitation in the research is that these trials occurred in experienced ECMO/ECPR centers, making it harder to generalize.

4. Seizure Considerations

Patients experiencing cardiac arrest who subsequently regain spontaneous circulation are at serious risk for brain injury related to a lack of oxygen to the brain. The 2023 CLS updates acknowledge that, for patients with electroencephalography (EEG) patterns suggesting seizure activity, a therapeutic trial of a nonsedating antiseizure medication may be reasonable.

Rationale

In the setting of cardiac arrest, where a patient’s brain may not receive adequate oxygenation, postanoxic seizures or status epilepticus have been associated with poor outcomes.

Although there is not a lot of high-level evidence, untreated clinically apparent seizure activity is thought to be potentially harmful to the brain. Considering cost versus benefit, treatment of seizures is recommended after cardiac arrest. The AHA realizes this recommendation is limited in the existing literature, and the detailed 2023 ACLS updates provide criteria for defining seizures to help clinicians standardize definitions.

5. Organ Donation

The 2023 ACLS updates seek to reinforce organ donation as an important outcome that should be considered. In the development and evaluation of a systems mindset in healthcare across the country, organ donation with the support of meaningful data has proven to be a life-sustaining resource time and time again.

Rationale

An average of 16 people in the U.S. die every day waiting for an organ transplant. Contemporary studies have shown that organ recipient outcomes are similar when transplanted organs are recovered from cardiac arrest patients. Organ donation after cardiac arrest directly benefits countless recipient patients and is an important outcome that is rarely identified as associated with cardiac arrest clinical trials.

Learn More about the 2024 ACLS Updates

Organizations like the AHA are pushing the boundaries of resuscitation science, supporting a continued assessment of the strategies guiding our care of the sickest patient populations. Healthcare professionals are on the front lines changing outcomes with the most recent updates and ACLS skills.

Premiere is committed to arming nurses and physicians with these lifesaving skills through online certifications and renewals that always incorporate the latest guidelines, like the 2023 ACLS updates. Our award-winning online courses, certifications, and recertifications cover a wide range of key CE requirements that help healthcare professionals stay current and develop their careers.

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