ACLS 2015 Guideline Changes

Changes to the American Heart Association’s 2015 ACLS Guidelines

The American Heart Association revised its ACLS Guidelines most recently in 2015 (next update is 2020). The changes to the previous ACLS guidelines were based on new research and outcomes data that emerged since the previous edition. Students who participated in an ACLS course before 2015 should be aware of the major changes listed below. This will affect most people who are seeking ACLS recertification.

Guideline Old Guideline 2015 Guideline
Sequence CAB (compressions, airway, breathing) Confirmed in the 2015 guidelines; do not delay the first 30 chest compressions
Compression depth At least 2 inches in adults Between 5 cm and 6 cm (2 inches and 2.4 inches) in adults
Compression frequency At least 100 compressions per minute No less than 100, no more than 120
Chest recoil Allow the chest to fully recoil between compressions Confirmed in the 2015 guidelines; do not lean on the chest between compressions; allow the heart to fully fill with blood
Vasopressin Vasopressin may replace first or second dose of epinephrine Vasopressin plus epinephrine provides no advantage as a substitute for epinephrine
Epinephrine CPR was recommended over epinephrine Administer epinephrine ASAP for non‑shockable cardiac arrest rhythm
Delayed ventilation New recommendation for 2015 Witnessed cardiac arrest with shockable rhythm, EMS may delay positive-pressure ventilation for up to 3 cycles of 200 continuous chest compressions
Advanced airway When using an advanced airway, give 1 breath every 6 to 8 seconds or 8 to 10 breaths a minute Deliver 1 breath every 6 seconds (10 per minute) when using an advanced airway during CPR
Chain of survival Same chain of survival for in-hospital and out-of-hospital cardiac arrest In-hospital and out-of-hospital cardiac arrest chain of survival are different; primary providers and lay rescuers provide immediate care and then transfer care to the code team or EMS crew, respectively.
Extracorporeal CPR Insufficient information to recommend routine use of extracorporeal CPR Extracorporeal CPR may be considered instead of regular CPR for reversible cardiac arrest
Post-cardiac arrest New recommendation for 2015 Inadequate evidence to support the routine use of lidocaine and/or beta-blocker
Post-cardiac arrest Comatose patients should be cooled to between 32°C and 34°C for 12-24 hours Comatose patients with ROSC should be cooled to between 32°C and 36°C for >24 hrs
Post-cardiac arrest New recommendation for 2015 Consider avoiding/correcting hypotension systolic BP <90 or mean arterial pressure <65
  • Research shows that starting compressions earlier in the resuscitation process tends to increase survival rates.
  • The assessment of the victim’s breathing has been removed since responders often mistake gasping breathing for effective breathing.
  • Experts define high-quality CPR for an adult as:
    • A compression rate of 100 to 120 compressions per minute
    • A compression depth of 2 to 2.4 inches (5-6 cm)
    • Allowing the chest to return to normal position after each compression
    • Not interrupting CPR for specific treatments such as intravenous catheter insertions, delivery of medications, and insertion of advanced airways; instead, wait until preparation for defibrillation and do treatments during that lull in CPR
    • Decrease excessive ventilation.
  • The pulse check is less critical since many providers cannot reliably detect a pulse in an emergency.
  • Post-cardiac arrest care is formally started as soon as return of spontaneous circulation (ROSC) occurs.
  • Administer a vasopressor every 3 to 5 minutes; use an endotracheal (ET) tube, if available, until IV access is established.
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