Cardiac
Advanced Cardiac Life Support Concepts in EMS
Cardiac arrest physiology and resuscitation priorities informed by NIH and CDC cardiovascular guidance.
The chain of survival
Sudden cardiac arrest remains a major public health challenge.1 Paramedics extend the chain with advanced airway management, IV/IO access, medication administration, and rhythm analysis beyond AED capabilities.
High-quality CPR remains the centerpiece, NHLBI stresses compressions and defibrillation as life-saving fundamentals.2 Advanced airways should not interrupt compressions longer than necessary.
Rhythms and reversible causes
Treat shockable rhythms (VF/pulseless VT) with defibrillation and epinephrine per protocol. PEA and asystole demand compression quality and search for reversible causes: hypoxia, hypovolemia, hydrogen ion (acidosis), hypo-/hyperkalemia, hypothermia, tension pneumothorax, tamponade, toxins, thrombosis.
Capnography provides real-time feedback: sudden rise may signal return of spontaneous circulation (ROSC); flat trace during compressions suggests poor placement or futility, interpret in clinical context.
Post-ROSC care
After ROSC, avoid hyperventilation, support blood pressure, obtain 12-lead ECG, and consider targeted temperature management per protocol. Transport to appropriate receiving centers with early notification.
Family communication and scene debrief reduce psychological injury to bystanders and crews alike.
