Advanced Cardiac Life Support (ACLS) and ECG Rhythms

Introduction

Advanced Cardiac Life Support (ACLS) is a set of clinical algorithms used for managing medical emergencies related to cardiac arrest, stroke, and other life-threatening cardiovascular conditions. Understanding ECG rhythms is a fundamental component of ACLS, as it helps medical professionals determine the appropriate interventions.

Common ACLS ECG Rhythms

1. Normal Sinus Rhythm (NSR)

• Regular rhythm with a heart rate of 60-100 bpm.
• P-wave before each QRS complex.
• Indicates normal heart function.

2. Bradycardia (HR < 60 bpm)

• Sinus Bradycardia: Slow but regular heart rhythm.
• Heart Blocks: Issues in electrical conduction (First, Second, and Third-degree AV blocks).
• Treatment: Atropine, pacing, or epinephrine if symptomatic.

3. Tachycardia (HR > 100 bpm)

• Narrow QRS Tachycardia:
  • Supraventricular Tachycardia (SVT): Rapid heartbeat originating above the ventricles.
  • Atrial Fibrillation: Irregularly irregular rhythm without distinct P-waves.
  • Management: Vagal maneuvers, adenosine, beta-blockers, or cardioversion based on patient stability.
• Wide QRS Tachycardia:
  • Ventricular Tachycardia (VT): Organized but rapid ventricular activity.
  • Ventricular Fibrillation (VF): Chaotic electrical activity requiring immediate defibrillation.

4. Pulseless Rhythms (Cardiac Arrest)

• Pulseless Electrical Activity (PEA): Electrical activity without cardiac output.
• Asystole: Complete lack of electrical activity (flat line on ECG).
• Treatment: High-quality CPR, epinephrine, and addressing reversible causes (H’s and T’s: Hypoxia, Hypovolemia, Hyperkalemia, Tamponade, Toxins, etc.).

Conclusion

Recognition of ECG rhythms is crucial in ACLS for timely and appropriate intervention. Treatment depends on whether the patient has a pulse, rhythm stability, and underlying cause.

Recommended Guidelines

• Follow American Heart Association (AHA) Guidelines for ACLS protocol.
• Refer to European Resuscitation Council Guidelines for further management in cardiac emergencies.

Source recommendations

1. American Heart Association (AHA) Guidelines

1. https://professional.heart.org/en/guidelines-and-statements
2. https://www.heart.org/
3. https://professional.heart.org/en/guidelines-statements
4. https://www.heart.org/en/healthy-living/fitness/fitness-basics/aha-recs-for-physical-activity-in-adults
5. https://cpr.heart.org/en/

2. European Resuscitation Council Guidelines

1. https://cprguidelines.eu/guidelines-2021
2. https://www.erc.edu/
3. https://cprguidelines.eu/
4. https://www.sciencedirect.com/science/article/pii/S0300957221000551
5. https://pubmed.ncbi.nlm.nih.gov/33773835/