ACLS, or Advanced Cardiac Life Support, is often used to refer to a course or a certification, but it is a set of clinical algorithms used for the treatment of life threatening cardiovascular conditions that were originally published in 1974 by the American Heart Association, and which have been regularly updated since.
Worldwide resuscitation research is evaluated every five years by the International Liaison Committee on Resuscitation, resulting in updates of guidelines by resuscitation organizations worldwide, like the American Heart Association, most recently in 2010. The ILCOR process involves experts in the fields of cardiology, critical care, neurology, and pulmonology, as well as specialists in the science of resuscitation. Extensive reviews are conducted of all important research in the field of resuscitation, and results are evaluated in light of the strengths and weaknesses of each study. Methodology, statistical analysis, and results are rigorously studied before recommendations are made.
ILCOR was formed in 1992 to provide a forum for communication between the resuscitation organizations throughout the world. ILCOR defines its objectives as the provision of a forum for discussion and coordination of all aspects of cardiopulmonary and cerebral resuscitation worldwide. They disseminate information on training and education in resuscitation, foster scientific research in areas of resuscitation where there is either controversy or a paucity of data. They provide the mechanism for the collection, review and collaboration on international scientific data on resuscitation, and produce statements that reflect international consensus.
ILCOR identifies and prioritizes questions, assigning reviewers and specifying minimal requirements for all search strategies, which include the Cochrane Systematic Reviews, Medline, and Embase. The quality and level of evidence is rated using a standardized evaluation form. International task forces evaluate evidence in the areas of Advanced Life Support, Basic Life Support, Pediatric Life Support, Neonatal Life Support, Acute Coronary Syndrome, Education, Implementation, and Teams.
After studies are examined, ILCOR holds several meetings a year. In 2010, the culmination of the process was the international consensus on CPR and ECC Science with Treatment Recommendations conference. An updated statement representing the consensus of experts from around the world was published later in 2010. From this statement, resuscitation organizations worldwide compile their individual guidelines for ECC and CPR. They also publish practitioner recommendations. These organizations include the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation, the Resuscitation Council of Southern Africa, and many more regional or national organizations.
Gaps in knowledge are also addressed to suggest areas of further study that could lead to new recommendations in the next cycle of research. The next International Consensus Conference will be held in February of 2015, and the ILCOR CoSTR and Guidelines will be published in late 2015. Prior to 2010, task forces were appointed to answer specific questions, such as "In adult and pediatric patients with cardiac arrest, does the use of any specific placement of hands for external chest compressions compared with standard care (e.g. "Placement of the rescuer's hands in the middle of the chest"), improve outcome (eg. ROSC, survival)" (www.ILCOR.org/consensus-2010/questions-2010).
The treatment guidelines that you learn in Advanced Cardiac Life Support represent the application of rigorous evidence to clinical practice. Sub-optimal adherence to guidelines results in poorer outcomes, which is why the system of algorithms developed to teach techniques for resuscitation are emphasized. Because the body of evidence for these guidelines is so strong, the importance of learning the correct treatment for resuscitation emergencies is critical. This is why there is such an emphasis on practice and memorization, with much attention given to decision points in each clinical pathway.
Clinical guidelines based upon evidence have been shown to increase effectiveness of treatment when understood and applied uniformly. Advanced cardiac life support addresses a number of conditions, which range from sudden cardiac arrest to acute coronary syndromes to stroke recognition and treatment. There were several significant guideline changes in 2010, including the increased emphasis on minimal interruption of CPR, the integration of AED use, and changes in several of the algorithms. Some drugs previously used were found to have no benefit or potentially harmful effects, and were dropped from various algorithms. Atropine, for example, was found to have no benefit in PEA or asystole. The 2010 Guidelines adapted from the ILCOR consensus statement by the AHA and the American College of Cardiologists were published in a series of articles in the journal Circulation. We can expect new evidence to lead to better practices with the 2015 consensus statement.
ACLS courses are available online and in classroom settings, and certification is often required for healthcare professionals. There are a variety of routes to certification. It is incumbent upon the healthcare provider to take advantage of the wealth of material on sites dedicated to ACLS learning, which include didactic materials and test questions, as well as simulated "megacodes." The goal of ACLS Certification is not certification, but preparation for real emergencies faced daily by healthcare providers who are in a position to utilize the best evidence available to provide life-saving interventions.