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At least 19 recordsLinked to original sources
PubMed2006

[Assessment of physicians employed in emergency medical services about their level of knowledge on basic life support, advanced cardiac life support and medicolegal responsibilities].

BACKGROUND: We aimed to determine the level of knowledge of Emergency Medical Services (EMS) physicians on Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS) and medicolegal responsibilities in conjunction with related factors. METHODS: Fifty-three physicians (43 male, 10 females; mean age 39 years; range 28 to 50 years) employed in EMS were required to respond a questionnaire consisting of demographic data and educational background. They also answered 25 multiple-choice questions about BLS, ACLS and medicolegal responsibilities of physicians in a face-to-face manner. The data were analyzed using Mann-Whitney U-test and Kruskal-Wallis Analysis of Variance test. RESULTS: Mean level of knowledge was 45.4 on a hundred-point scale. Attendance to courses covering emergency aid and working as an ambulance physician for more than one year were associated with higher levels of knowledge (p=0.012; p=0.015). CONCLUSION: In-service training should be undertaken to raise the level of knowledge of the physicians employed in rural EMS and to improve the quality of field care.

Adult↗
PubMedDate not supplied

Resuscitation. II: Advanced cardiac life support.

Advanced cardiac life support is the definitive sequence of initial treatment for the victim of a cardiac arrest. Advanced cardiac life support forms a large part of cardiopulmonary resuscitation, which also includes basic life support and post-resuscitation intensive care.

Algorithms↗
PubMed1993

Basic Life Support and Advanced Cardiac Life Support changes.

Short article that delineates recent changes in Basic Life Support and Advanced Cardiac Life Support. These changes are based on recommendations from the 1992 National Conference on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC).

Adult↗
PubMed1985

The effect of an advanced cardiac life support course on advanced cardiac life support ability.

Thousands of health care providers spend time, money, and energy each year taking the AHA-sponsored ACLS courses, and ACLS-certified health care providers are frequently given greater job responsibility than other health care providers in the same setting. The purpose of this study was to determine the effect of an ACLS course on the ability of health care providers to perform ACLS in a simulated situation. A nonequivalent control group design was used. The sample consisted of 76 health care providers whose job responsibilities included ACLS. The Mega-Code skill station from the ACLS course was used to evaluate ACLS performance. Chi-square analyses showed a significant (p less than 0.05) difference in the posttest pass/fail results of the two groups and a significant (p less than 0.05) difference in the changes from pretest to posttest of the two groups. The research hypotheses were supported, and the researches concluded that the course had a positive effect on the subjects' ACLS ability.

Clinical Competence↗
PubMed1999

Use of a computerized advanced cardiac life support simulator improves retention of advanced cardiac life support guidelines better than a textbook review.

OBJECTIVE: To determine whether an advanced cardiac life support (ACLS) computer simulation program improves retention of ACLS guidelines more effectively than textbook review. DESIGN: Randomized, controlled trial. SETTING: Academic medical center. PARTICIPANTS: Forty-five anesthesia residents and faculty tested 10 to 11 months after ACLS provider course training. INTERVENTION: Participants were randomized and asked to prepare for a mock resuscitation (Mega Code) with either textbooks or a computerized ACLS simulation program. MAIN OUTCOME MEASURE: Performance on a standardized Mega Code examination that required application of supraventricular tachycardia, ventricular fibrillation, and second-degree Type II atrioventricular block algorithms. Mega Code sessions were administered by an instructor who was blinded as to the subject group. The sessions were videotaped and scored by two evaluators who also were blinded as to the subject group. RESULTS: Participants who used the ACLS simulation program scored significantly higher (mean 34.9 +/- 5.0 [SD] of 47 possible points) than participants who reviewed using a textbook (29.2 +/- 4.9); p < .001. Pass-fail rates for the algorithms were also higher for the group that reviewed with the simulator (mean 2.5 +/- 0.5 of 3 possible passes) than the group that used the textbook (1.6 +/- 1.0); p = .001. CONCLUSIONS: Use of a computerized ACLS simulation program improves retention of ACLS guidelines better than textbook review.

Academic Medical Centers↗
PubMed1993

Education in adult advanced cardiac life support training programs: changing the paradigm. Members of the Advanced Cardiac Life Support Education Panel.

To develop a consensus for change in the educational aspects of the Advanced Cardiac Life Support (ACLS) Training Program, the American Heart Association appointed panel members to engage in a consensus process. At a preconference meeting held in the fall of 1991, panel members received broad input from experts in adult education, experienced ACLS educators, and resuscitation scientists. The panel then developed a statement based on the preconference discussions and presented it at the National Conference on CPR and Emergency Cardiac Care held in February 1992. The conference's recommendations and the process that led to them are described in this paper. The key conclusions of the consensus process are as follows. The purpose of ACLS programs is the education of health professionals whose jobs include the management of patients in arrest or near-arrest. The goal of each ACLS course is to have each participant succeed in acquiring the skills and knowledge required for resuscitation. Aspects of the course which threaten failure or raise anxiety should be minimized or eliminated. ACLS course directors are strongly encouraged to design courses whose content and presentation are best suited to the training, experience, and needs of the course participants. Flexibility is strongly encouraged. Evaluation (testing) should be used primarily for its educational value, to help both learners and instructors identify areas needing improvement. The problem learner should be identified as early as possible and should receive intensive remediation to achieve the goal of every participant acquiring the targeted skills and knowledge. Because skill retention is variable, rescuers should practice skills frequently in regular refresher sessions. At a minimum, retraining every two years is strongly recommended.

Adult↗
PubMed2006

Pharmacotherapy considerations in advanced cardiac life support.

Cardiac arrest and sudden cardiac death remain major causes of mortality. Early intervention has been facilitated by emergency medical response systems and the development of training programs in basic life support and advanced cardiac life support (ACLS). Despite the implementation of these programs, the likelihood of a meaningful outcome in many life-threatening situations remains poor. Pharmacotherapy plays a role in the management of patients with cardiac arrest, with new guidelines for ACLS available in 2005 providing recommendations for the role of specific drug therapies. Epinephrine continues as a recommended means to facilitate defibrillation in patients with pulseless ventricular tachycardia or ventricular fibrillation; vasopressin is an alternative. Amiodarone is the primary antiarrhythmic drug that has been shown to be effective for facilitation of defibrillation in patients with pulseless ventricular tachycardia or fibrillation and is also used for the management of atrial fibrillation and hemodynamically stable ventricular tachycardia. Epinephrine and atropine are the primary agents used for the management of asystole and pulseless electrical activity. Treatment of electrolyte abnormalities, severe hypotension, pulmonary embolism, acute ischemic stroke, and toxicologic emergencies are important components of ACLS management. Selection of the appropriate drug, dose, and timing and route of administration are among the many challenges faced in this setting. Pharmacists who are properly educated and trained regarding the use of pharmacotherapy for patients requiring ACLS can help maximize the likelihood of positive patient outcomes.

Advanced Cardiac Life Support↗
PubMed1999

An interactive multimedia training system for advanced cardiac life support.

This paper describes an Advanced cardiac life support (ACLS) training system (ACLSYS) with multimedia and hypertext features for training medical personnel and evaluating their performance during ACLS events. ACLSYS runs in a Windows 95 environment and is written in Visual Basic 4.0 Enterprise Edition and Access 7.0. The system consists of two primary modules: a multimedia training module and a simulation/evaluation module. The training module provides the knowledge and skills required for the appropriate early treatment of cardiopulmonary arrest. The simulation/evaluation module generates randomly an unlimited number of ACLS cases. These cases become part of the training case database and are available for retraining. ACLS certified personnel were included in the validation of the system.

Cardiopulmonary Resuscitation↗
PubMedDate not supplied

Recent progress in advanced cardiac life support.

The revised guidelines for advanced cardiac life support (ACLS) from the American Heart Association are anticipated in the fall of 2000. Although dramatic changes in the approach to adult basic and ACLS are not anticipated, several controversies and new drugs on the horizon may radically change our approach to emergent cardiac resuscitation. This article features some of the evolving thinking on the emergent treatment of the adult with ventricular fibrillation or ventricular tachycardia, the critical rhythms seen in most cases of acute cardiac distress. Approaches to airway therapy drug administration and new agents also are described.

Adult↗
PubMed1976

Training in advanced cardiac life support.

The nationally recognized training and certification program in Advanced Cardiac Life Support consists of lecture material and a new concept in training and testing for the practical skills of Advanced Cardiac Life Support. The course content follows closely the concepts of advanced life support as explained in the standards on cardiopulmonary resuscitation and emergency cardiac care.

Allied Health Personnel↗
PubMed2004

Advanced cardiac life support in out-of-hospital cardiac arrest.

BACKGROUND: The Ontario Prehospital Advanced Life Support (OPALS) Study tested the incremental effect on the rate of survival after out-of-hospital cardiac arrest of adding a program of advanced life support to a program of rapid defibrillation. METHODS: This multicenter, controlled clinical trial was conducted in 17 cities before and after advanced-life-support programs were instituted and enrolled 5638 patients who had had cardiac arrest outside the hospital. Of those patients, 1391 were enrolled during the rapid-defibrillation phase and 4247 during the subsequent advanced-life-support phase. Paramedics were trained in standard advanced life support, which includes endotracheal intubation and the administration of intravenous drugs. RESULTS: From the rapid-defibrillation phase to the advanced-life-support phase, the rate of admission to a hospital increased significantly (10.9 percent vs. 14.6 percent, P<0.001), but the rate of survival to hospital discharge did not (5.0 percent vs. 5.1 percent, P=0.83). The multivariate odds ratio for survival after advanced life support was 1.1 (95 percent confidence interval, 0.8 to 1.5); after an arrest witnessed by a bystander, 4.4 (95 percent confidence interval, 3.1 to 6.4); after cardiopulmonary resuscitation administered by a bystander, 3.7 (95 percent confidence interval, 2.5 to 5.4); and after rapid defibrillation, 3.4 (95 percent confidence interval, 1.4 to 8.4). There was no improvement in the rate of survival with the use of advanced life support in any subgroup. CONCLUSIONS: The addition of advanced-life-support interventions did not improve the rate of survival after out-of-hospital cardiac arrest in a previously optimized emergency-medical-services system of rapid defibrillation. In order to save lives, health care planners should make cardiopulmonary resuscitation by citizens and rapid-defibrillation responses a priority for the resources of emergency-medical-services systems.

Adolescent↗
PubMedDate not supplied

Evaluation of advanced cardiac life support written examinations.

OBJECTIVE: To examine the quality of 2 advanced cardiac life support written examinations and the relationship between demographic variables and test performance. DESIGN: Descriptive. SETTING: Advanced cardiac life support courses held at 4 midwestern hospitals, one outpatient surgery center, and one community college. SUBJECTS: Nonprobability sample of 367 participants. OUTCOME MEASURE: Two versions of the American Heart Association advanced cardiac life support written examinations. RESULTS: Reliability coefficients of test A and test B were 0.45 and 0.54, respectively. Discrimination and difficulty indices calculated on both tests revealed that test B questions were more difficult, with better discriminators. Prior experience, sex of participant, and profession were identified as factors influencing test performance. CONCLUSION: Although test B surpassed the performance of test A, both examinations were problematic. Additional investigation and refinement of the advanced cardiac life support tests are warranted.

Analysis of Variance↗
PubMed1995

Physician compliance with advanced cardiac life support guidelines.

STUDY OBJECTIVE: To determine compliance with advanced cardiac life support (ACLS) guidelines among ACLS-certified and non-ACLS-certified physicians. DESIGN: Retrospective review of consecutive cardiac arrests between July 1989 and June 1990, including assessment of the resuscitation leaders' ACLS certification. SETTING AND PARTICIPANTS: All nontraumatic prehospital and hospital cardiac arrests in a rural university hospital. RESULTS: Two hundred seven arrests were studied for a total of 436 rhythms with a maximum of 4 rhythms per arrest. There were 78 resuscitations (36.3%) with return of spontaneous circulation. A total of 2,038 interventions were recorded for all rhythms, with 1,320 (64.8%) compliant with ACLS guidelines compared with 718 (35.2%) deviations. Synchronized cardioversion, calcium chloride and sodium bicarbonate were used with significantly higher noncompliance. Ventricular fibrillation had significantly higher mean rhythm deviation scores, whereas scores were significantly lower for sinus rhythm and stable bradycardia (P < .003). Resuscitations led by ACLS-certified and non-ACLS-certified physicians were compared for mean number of deviations per resuscitation attempt, and no differences were found. Resuscitations with return of spontaneous circulation were compared with unsuccessful resuscitations, and there was no difference between groups in controlled deviation scores. No differences could be found between ACLS-certified and non-ACLS-certified physicians for return of spontaneous circulation and survival-to-discharge rates. CONCLUSION: Despite biannual ACLS training of all medical residents and ICU nurses, noncompliance with ACLS guidelines was noted in 35.2% of treatments. We found no correlation between ACLS certification and ACLS guideline compliance.

Cardiopulmonary Resuscitation↗
PubMed1993

An experimental algorithm versus standard advanced cardiac life support in a swine model of out-of-hospital cardiac arrest.

STUDY OBJECTIVE: To compare an experimental algorithm with standard advanced cardiac life support in a swine model of out-of-hospital cardiac arrest. DESIGN: Randomized, controlled experimental trial. SETTING/TYPE OF PARTICIPANT: Animal laboratory using swine. INTERVENTIONS: Eighteen swine (17.8 to 23.7 kg) were sedated, intubated, anesthetized, and instrumented for monitoring of arterial and central venous pressures and ECG. Ventricular fibrillation was induced using a bipolar pacing catheter. Animals were randomized to treatment with the experimental algorithm or standard advanced cardiac life support therapy after eight minutes of untreated ventricular fibrillation. The experimental algorithm consisted of starting CPR; giving high-dose epinephrine (0.20 mg/kg), lidocaine (1.0 mg/kg), bretylium (5.0 mg/kg), and propranolol (0.5 to 1.0 mg) by peripheral IV; hyperventilating (20 to 25 breaths per minute); and delaying countershock (5 J/kg) 60 seconds after completion of drug delivery. Data were analyzed with the Student's t-test and Fisher's exact test. MEASUREMENTS AND MAIN RESULTS: Outcome variables were arterial and central venous pressures, return of spontaneous circulation, and one-hour survival. Hemodynamics were not different between groups during CPR. Return of spontaneous circulation occurred in seven of nine swine (77%) in the experimental algorithm group versus two of nine swine (22%) in the advanced cardiac life support group (P = .057). Four of nine swine (44%) in the experimental algorithm group survived to one hour versus none of the animals in the advanced cardiac life support group (P = .041). CONCLUSION: In this swine model of out-of-hospital cardiac arrest, animals treated with an experimental algorithm had a significant improvement in one-hour survival compared with those treated with advanced cardiac life support.

Algorithms↗