2020 ACLS

2020 American Heart Association Guidelines for Adult Basic and Advanced Life Support

In Featured, Infographics by Samuel Wilson1 Comment

This year, the American Heart Association (AHA) released the updated 2020 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care; the first major update to the internationally recognized guideline in five years.

In collaboration with the AHA, the authors highlighted the “Top 10 Things to Know” regarding the guideline updates. As in previous years, the authors emphasize recognizing prevalence and mortality of cardiac arrest in both a community and hospital setting. They also reaffirm the well-known components of high-quality CPR, epinephrine use, early defibrillation, and vascular access. Special circumstances are discussed, including opioid overdose and cardiac arrest in pregnancy. Evidence for new technologies such as point-of-care ultrasound is also discussed. Found below are the updates in detail:

1. Over 350,000 Emergency Medical Services-assessed cardiac arrests and 209,000 in-hospital cardiac arrests occur annually in the United States. Despite advances in resuscitation science, survival rates for out of hospital cardiac arrest are only at best about 10%.  Survival from in-hospital cardiac arrest is about 25%.

2. The 2020 Guidelines is based on the extensive evidence evaluation performed in conjunction with the International Liaison Committee on Resuscitation and affiliated International Liaison Committee on Resuscitation member councils. Three different types of evidence reviews (systematic reviews, scoping reviews, and evidence updates) were used in the 2020 process. Each of these resulted in a description of the literature that facilitated guideline development.

3. These guidelines reaffirmed the components of high-quality CPR, including compression depth (5 cm) and rate (100-120/min).  In addition, the guidelines reaffirmed early epinephrine administration emphasizing epinephrine administration as soon as feasible for nonshockable rhythms, and epinephrine administration of epinephrine for shockable rhythms to occur after initial defibrillation attempts have failed. 

4. Along with CPR, early defibrillation is critical to survival when sudden cardiac arrest is caused by ventricular fibrillation or pulseless ventricular tachycardia. Double sequential defibrillation—shock delivery by 2 defibrillators nearly simultaneously—has emerged as a new technological approach to manage these patients; however, its usefulness for refractory shockable rhythms has not been established. 

5. The peripheral IV route has been the traditional approach for giving emergency pharmacotherapy, although the IO route has grown in popularity and is increasingly implemented as a first-line approach for vascular access. This recommendation has been updated to include emphasis on IV as the first attempt, and IO may be used when IV access is unsuccessful or not feasible. 

6. Not all cardiac arrest events are identical, and specialized management may be critical for optimal patient outcome. These guidelines focus on two special circumstances that require individualized management of resuscitation; opioid overdose and cardiac arrest in pregnancy.

7. This guideline also discusses the synthesis of evidence for new technologies like point-of-care ultrasound for prognostication and whether their use is advised.

8. These guidelines also looked at post resuscitative care, including post-cardiac arrest care and guidance in improving Neuroprognostication. For post-cardiac arrest care, there is a new algorithm that describes the initial stabilization phase and additional emergency activities after return of spontaneous circulation (ROSC). This guideline also considers guidance needed for accurate neurologic prognostication in cardiac arrest survivors who do not regain consciousness with ROSC is critically important to ensure that patients with significant potential for recovery are not destined for certain poor outcomes due to care withdrawal.

9. We have added an additional link in the Chain of Survival: recovery from cardiac arrest. Recovery expectations and survivorship plans that address treatment, surveillance, and rehabilitation need to be provided to cardiac arrest survivors and their caregivers at hospital discharge to address the sequelae of cardiac arrest and optimize transitions of care to independent physical, social, emotional, and role function.

10. Cardiac arrest remains a condition with considerable morbidity and mortality that broadly affects individuals across age, gender, race, geography, and socioeconomic status. Although there have been modest improvements in survival, there is still considerable work to be done to address the significant burden of this disease.

To learn more about the Must Know changes around the other guidelines, check out here.

This post was copyedited by Samuel Wilson (@samwilson_95) and Andy Tolmie (@atolm6).

Further reading:

Heart & Stroke 2020 Guidelines for CPR and Emergency Cardiovascular Care

American Heart Association 2020 Guidelines for CPR and Emergency Cardiovascular Care

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Samuel Wilson

Samuel Wilson

Sam is a fourth-year medical student from the University of Ottawa. He is a CanadiEM Infographic editor interested in EM, PoCUS, medical teaching, and exploring the outdoors.
Samuel Wilson
- 3 months ago
Sparsh Shah

Sparsh Shah

Sparsh Shah is an incoming Emergency Medicine Resident at the University of Toronto. He has interests in trauma, global health, and healthcare innovation.
Alvin Chin
Alvin is currently a PGY5 in the FRCP EM program at McMaster University. He serves as Director of Design for CanadiEM and has interests in knowledge translation and health innovation.
Alvin Chin
- 3 days ago
Comilla Sasson

Comilla Sasson

Comilla Sasson, MD, PhD is an Emergency Medicine Physician and serves as the Vice President of Science & Innovation, Emergency Cardiovascular Care at the American Heart Association.
Comilla Sasson
- 4 hours ago