• Dr. Mike Kirlew MD CCFP

NEW ACLS Updates: A Brief Summary of Pertinent Changes

ACLS was UPDATED in late 2018! Here is a brief summary of pertinent changes:

Basic Life Support Changes

Excellent compression with minimum interruptions are paramount (no big surprise there). Compression depth of at least 5cm and no more than 6cm. Extra focus this time around on ensuring complete recoil. Make sure you do not lean on the chest.

Compression rate of between 100-120. Greater than 120 is associated with worse outcomes.

With an advanced airway ventilation rate is 1 breath every 6 second for everyone including pediatrics.

Medication Changes

Consider now giving Amiodorone or Lidocaine for pVT /Vfib refractory to Defibrillation and Epinephrine. Not enough evidence to support or refute b-blockers or Lidocaine after ROSC. Potentially can be considered in a patient with Recurrent episodes of Ventricular Tachycardia.

Useful Pearls

  • ETCO2 is your friend. Helps you in a cardiac arrest confirm tube placement but also assist with Adequacy of Compression (ETCO2< 10 .patient needs better CPR) ETCO2 > 40 mmHg can indicate a return of spontaneous circulation.

  • Make sure the BP Cuff is on during CPR. Diastolic Pressure < 20 mmHg means try to do better CPR.


Duff JP, Topjian A, Berg MD, et al. 2018 American Heart Association focused update on pediatric advanced life support: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care [published online November 5, 2018]. Circulation.

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