EvidenceAlerts

Perman SM, Elmer J, Maciel CB, et al. 2023 American Heart Association Focused Update on Adult Advanced Cardiovascular Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2024 Jan 30;149(5):e254-e273. doi: 10.1161/CIR.0000000000001194. Epub 2023 Dec 18. (Evidence-based guideline)
Abstract

Cardiac arrest is common and deadly, affecting up to 700 000 people in the United States annually. Advanced cardiac life support measures are commonly used to improve outcomes. This "2023 American Heart Association Focused Update on Adult Advanced Cardiovascular Life Support" summarizes the most recent published evidence for and recommendations on the use of medications, temperature management, percutaneous coronary angiography, extracorporeal cardiopulmonary resuscitation, and seizure management in this population. We discuss the lack of data in recent cardiac arrest literature that limits our ability to evaluate diversity, equity, and inclusion in this population. Last, we consider how the cardiac arrest population may make up an important pool of organ donors for those awaiting organ transplantation.

Ratings
Discipline Area Score
Cardiology 7 / 7
Emergency Medicine 7 / 7
Hospital Doctor/Hospitalists 7 / 7
Internal Medicine 7 / 7
Intensivist/Critical Care 6 / 7
Comments from MORE raters

Cardiology rater

This article is definitely interesting and gives some new information. As a cardiologist, this information will be useful not only in my practice, but also because we are called on to discuss these issues with many of our colleagues in hospital.

Emergency Medicine rater

This focused update of the AHA guidelines provides a few new recommendations that will affect clinicians' habits, such as the recommendation against routine calcium.

Hospital Doctor/Hospitalists rater

As a practicing hospitalist, this is a welcome review and update.

Hospital Doctor/Hospitalists rater

This article provides the 2023 updates to the ACLS guidelines and the evidence and references that support the updates.

Hospital Doctor/Hospitalists rater

The guidelines shed light and clarity on some of the controversial areas in post-cardiac arrest management, especially targeted temperature management. They also reaffirm certain practices crucial in ACLS algorithms.

Intensivist/Critical Care rater

The 2023 AHA Updated ACLS Guideline has important new recommendations: 1. epinephrine should be administered to all patients with nonshockable rhythms; 2. patients with refractory fibrillation should also receive epinephrine and also be considered for amiodarone or lidocaine; 3. routine administration of calcium, sodium bicarbonate, and magnesium is not recommended; 4. if available, extracorporeal cardiopulmonary bypass bears consideration for select patients with cardiac arrest refractory to standard ACLS; 5. coronary angiography should be performed emergently on all patients with cardiac arrest and evidence of an ST-elevation ACS; 6. all adults who do not follow commands after ROSC should receive targeted temperature control 32-37.5C for 24 hours; 7. seizure activity should be treated with anticonvulsants; and 8.organ donation should be considered for patients resuscitated from cardiac arrest who meet criteria for brain death or before planned withdrawal of life support.

Internal Medicine rater

Important update.
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