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New – 2023 AHA ACLS Updates

January 4, 2024

Written by Amanda Mathews

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In this focused update to the AHA Guidelines for Cardiopulmonary Resuscitation (last updated 2020), the study group recommended against routine use of calcium in cardiac arrest while recommending for a targeted temperature control strategy in patients who do not follow commands post ROSC, among other recommendations.

Throw away your calcium and get out your thermometers
The AHA Advanced Life Support Focused Writing Group consists of experts in multiples fields including EM, EMS, pulmonary critical care, neurocritical care, and interventional cardiology. This group routinely meets to update guidelines for treatment of cardiac arrest. The 2023 update reiterates many things we already knew, such as giving epinephrine instead of vasopressin and not using sodium bicarbonate routinely in cardiac arrest.

Pertinent 2023 updates include:

  • Recent data suggest that the routine use of calcium, outside of special circumstances (hyperkalemia, calcium channel blocker overdose), is associated with harm. (Level 3 recommendation: no benefit)
  • RCTs have not found magnesium to improve ROSC, survival, or neuro outcomes regardless of presenting rhythm. (Level 3: no benefit)
  • Use of ECPR in ACLS refractory cardiac arrests is reasonable in select patients when provided within an appropriately trained and equipped system of care. (Level 2a: moderate)
  • Emergent coronary angiography is not recommended over a delayed or selective strategy in patients with ROSC after cardiac arrest in the absence of ST-segment elevation, shock, electrical instability, signs of significant myocardial damage, and ongoing ischemia. (Level 3: no benefit)
  • All adults who do not follow commands post ROSC should have a deliberate strategy for temperature control with a constant temperature between 32-37.5o C recommended. (Level 1: strong)

How will this change my practice?
It is always educational to check in on the latest cardiac arrest literature, and this update reinforced a lot of things we are already doing at my institution. I will keep a closer eye on patient temperature post ROSC and think carefully before giving calcium without a clear reason in the future.

American Heart Association. 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. 2023 Dec 18. doi: 10.1161/CIR.0000000000001194. Epub ahead of print.