Advanced Life Support Clinical Practice Guidelines (ESC, 2021)

European Resuscitation Council

These are some of the highlights of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

June 03, 2021

Clinical practice guidelines on adult advanced life support (ALS) were published in April 2021 by the European Resuscitation Council (ERC) inResuscitation.[1]

The ERC guidelines on ALS in adults focus on the prevention and treatment of both in-hospital and out-of-hospital cardiac arrest.

Prevention of Cardiac Arrest

For hospitals, an early warning score system is recommended to identify patients who are critically ill or who are at risk for clinical deterioration. In the outpatient setting, the following premonitory signs and symptoms that are consistent with an arrhythmia should be investigated:

  • Syncope (especially during exercise or while sitting or supine)

  • Palpitations

  • Dizziness

  • Sudden shortness of breath

Treatment of Cardiac Arrest

Begin cardiopulmonary resuscitation (CPR) without delay. Verify that the patient is in ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT) and defibrillate once. Immediately resume chest compressions.

Initiate a basic airway technique during CPR and progress to an advanced technique until effective ventilation is achieved. Tracheal intubation should be used only by rescuers with a high rate of previous successful attempts. Waveform capnography is recommended to confirm the position of the tracheal tube. Minimize any interruptions to the chest compressions.

Administer adrenaline (1 mg) as early as possible for patients in cardiac arrest with a non-shockable rhythm. For those with a shockable rhythm, administer adrenaline (1 mg) after three defibrillation attempts.

Administer amiodarone (300 mg) to patients who are in VF/pVT after three shocks have been given. Consider an additional dose of amiodarone (150 mg) for patients who are in VF/pVT after five shocks have been given.

Identify and correct any reversible causes of cardiac arrest.

If conventional ALS techniques are not successful, consider extracorporeal CPR as a rescue therapy.

For more information, please go to Cardiopulmonary Resuscitation (CPR).

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