Algorithms for Advanced Cardiac Life Support 2021

2020 updated guidelines have been published by American Heart Association^®, by enrolling in our courses you will receive our ACLS & BLS courses that follow 2020 American Heart Association^® Guidelines for CPR and ECC, PALS course follows 2016 AHA Guidelines for CPR & ECC. Please note that our company typically implements new training guidelines up to a year before AHA releases their updates.

One of the crucial components of effective ACLS training is a familiarity with the major algorithms for different patient and/or provider scenarios. As a free resource for our visitors, this page contains links to sample algorithms for the main AHA Advanced Cardiac Life Support cases. See our website terms. Compatible part number: 90-1013, 90-1010.

See our separate page for BLS Algorithms.

Cardiac arrest algorithm

This case presents the recommended assessment, intervention, and management options for a patient in respiratory arrest. The patient is unresponsive and unconscious. Respirations are absent or inadequate to maintain effective oxygenation and ventilation. The patient has a pulse. Even though the patient is in respiratory arrest and not in cardiac arrest, the BLS Primary Survey and the ACLS Secondary Survey are used.

Acute coronary syndromes algorithm

For this case, you use the Acute Coronary Syndromes Algorithm to guide the assessment and management of patients with signs and symptoms of acute coronary syndromes. A key focus of the case is the identification and treatment of ST-segment elevation myocardial infarction (STEMI). You use a 12-lead ECG to evaluate the patient's rhythm. You initiate treatment based on your assessment.

Video ACS Algorithm

Bradycardia algorithm

This case outlines how to assess and manage a patient with symptomatic bradycardia. The patient has a pulse. One of your tasks is to figure out if the patient's signs and symptoms are caused by the slow heart rate or have an unrelated cause. Another task is to correctly diagnose the presence and type of atrioventricular (AV) block and implement the correct management strategies for AV blocks. You also need to know the techniques and cautions for using transcutaneous pacing.

Bradycardia Algorithm

Tachycardia algorithms

This case presents the assessment and management of a stable patient with a pulse who has a heart rate greater than 100 bpm. Your tasks are to classify the tachycardia as narrow or wide, regular or irregular, and to implement the appropriate interventions from the ACLS Tachycardia Algorithm, including vagal maneuvers and adenosine. Monitor the patient's rhythm and request a cardiac consultation if the patient's rhythm does not convert. If the patient becomes unstable, follow the algorithm for unstable tachycardia. For unstable tachycardia, you evaluate the patient for cardioversion and perform the procedure. Drugs are not used to manage unstable tachycardia.

Stable Tachy.

VF/pulseless VT algorithm

This case presents how to respond to someone who collapses outside of the hospital setting from either ventricular fibrillation (VF) or ventricular tachycardia (VT). You are alone and must manage the patient by yourself. You do not have the option of ACLS interventions, including advanced airway control and IV medications. You have an automated external defibrillator (AED) with a pocket face mask. The second AED case focuses on the assessment and management of a patient in a witnessed cardiac arrest caused by ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT). The patient did not respond to the first shock. A manual defibrillator is used in this case, and you work with a care team.

PEA/asystole algorithm

Your task for this case is to assess and manage a patient in cardiac arrest who has pulseless electrical activity (PEA). Although the ECG shows organized cardiac electrical activity, the patient is unresponsive with no palpable pulse. Because finding and identifying an underlying cause is critical to patient outcome, the team searches for possible causes for PEA as they administer CPR. With asystole, you search with other members of the emergency care team for a treatable cause while performing high quality CPR with minimal interruptions. IV/IO placement is a priority over advanced airway management. The team discusses when to terminate resuscitation efforts and focus on supporting the patient's family.

Suspected stroke algorithm

This case presents the identification (Cincinnati Prehospital Stroke Scale) and initial management of patients with acute ischemic stroke, a sudden change in neurological function brought on by a change in blood flow to the brain. This case is in scope for ACLS providers and covers fundamental out-of-hospital care, as well as basic aspects of initial in-hospital acute stroke care. This includes out-of-hospital and in-hospital situations, and National Institute of Neurological Disorders and Stroke (NINDS) time goals.

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Anesthesia ACLS algorithms

These algorithms involve ACLS events in in-hospital settings for anesthetic and surgically related pathophysiology. Thank you to Vivek K. Moitra, MD, Andrea Gabrielli, MD, Gerald A. Maccioli, MD, and Michael F. O’Connor for providing this to us. Printed with permission.

Vivek K. Moitra, MD, Andrea Gabrielli, MD, Gerald A. Maccioli, MD, and Michael F. O’Connor, MD. Can J Anaesth. 2012 June; 59(6): 586-603.