The field of resuscitation has been evolving for more than two centuries . The Paris Academy of Science recommended mouth-to-mouth ventilation for drowning victims in 1740 . In 1891, Dr. Friedrich Maass performed the first documented chest compressions on humans . The American Heart Association (AHA) formally endorsed cardiopulmonary resuscitation (CPR) in 1963, and by 1966, they had adopted standardized CPR guidelines for instruction to lay-rescuers .
Advanced cardiac life support (ACLS) guidelines have evolved over the past several decades based on a combination of scientific evidence of variable strength and expert consensus. The American Heart Association (AHA) developed the most recent ACLS guidelines in 2010 using the comprehensive review of resuscitation literature performed by the International Liaison Committee on Resuscitation (ILCOR) [4,5]. Guidelines are reviewed continually, but are formally released every five years, and published in the journals Circulation and Resuscitation.
This topic will discuss the management of cardiac arrhythmias in adults as described in the 2010 ACLS Guidelines. The evidence supporting these guidelines is presented separately, as are issues related to controversial treatments for cardiac arrest patients, basic life support (BLS), airway management, and post-cardiac arrest management. (See "Supportive data for advanced cardiac life support in adults with sudden cardiac arrest" and "Therapies of uncertain benefit in basic and advanced cardiac life support" and "Basic life support (BLS) in adults" and "Basic airway management in adults" and "Advanced emergency airway management in adults" and "Post-cardiac arrest management in adults".)
EVIDENCE BASED GUIDELINES
Because of the nature of resuscitation research, few randomized controlled trials have been completed in humans. Many of the recommendations in the American Heart Association’s 2010 Guidelines for advanced cardiac life support (hereafter referred to as the 2010 ACLS Guidelines) are made based upon retrospective studies, animal studies, and expert consensus . Guideline recommendations are classified according to the GRADE system . The evidence supporting the 2010 ACLS Guidelines is reviewed in detail separately. (See "Supportive data for advanced cardiac life support in adults with sudden cardiac arrest".)
PRINCIPLES OF MANAGEMENT
Excellent basic life support and its importance — Excellent cardiopulmonary resuscitation (CPR) and early defibrillation for treatable arrhythmias remain the cornerstones of basic and advanced cardiac life support (ACLS). Although the 2010 American Heart Association (AHA) Guidelines for ACLS (2010 ACLS Guidelines) suggest several revisions, including medications, electrical therapy, and monitoring, the emphasis on excellent CPR and its critical role in resuscitative efforts remains unchanged (algorithm 1 and algorithm 2 and figure 1) . We emphasize the term “excellent CPR” because anything short of this standard does not achieve adequate cerebral and coronary perfusion, thereby compromising a patient’s chances for neurologically intact survival. CPR is discussed in detail separately; key principles in the performance of ACLS are summarized in the following table (table 1). (See "Basic life support (BLS) in adults".)