ACLS

My last ACLS course was back in 2010, before I left Dublin. It was compulsory then for a medical doctor to be equipped with ACLS before they can be scheduled for on-call.

ACLS is an advanced cardiovascular life support, kinda an extension from Basic Life Support (BLS). Once pass, you will be given certificate (usually by American Heart Association) that will last for 2 years. It was covered by training grant when I was in Ireland, so cost was not an issue.

In Malaysia, ACLS is a voluntary course. As far as I can remember, even BLS was not made compulsory, to be done every 2 years, for health professionals - or at least I was not doing that. I remember looking at the cost to sponsor a medical officers for an ACLS course. For an AHA certified program, the cost is SGD800 for 2 days!! So, I can see why it is difficult to make it compulsory without any financial help. Local ACLS program, but not AHA certified is available in some hospitals with much lesser price, but it is not popular and not readily advertised.

Do we really need to know ACLS? Does it really make much different? Knowledge is one thing, and practice is another. I am sure, many videos on life support is available. One can be really good at the theory of life support, but putting them into a well coordinated team work that synchronised very well is difficult. Other advantages of getting ACLS done, for me, are:

1. Updating myself on latest guideline.

Latest ACLS guideline was published in 2015 (every 5 years). With every new guideline, there will be some tweak with the resuscitation steps and medication used. Compared to the last ACLS in 2010, the current guideline do not stress too much on airway/breathing. The main focus is minimal interruption of good chest compression and early defibrillation. Another change I notice is the discontinuation of Atropine (1mg) as resuscitation drug in asystole/PEA protocol. There is no more vasopressin as well. Now, only adrenaline/epinephrine left in that segment. There is also now post-resuscitation care, especially using targeted temperature managemenet (TTM) to cool down patients for cerebral/heart protection.

I was also informed of a randomised study in 2013 using steroids as part of the measures during resuscitation. It showed that steroid used improved survival to hospital discharge. However, because it has not been repeated since, it has not made its way into the guideline.

2. Medico-legal loophole

Imagine if we were involved in a medico-legal case, and we were asked regarding an unsuccessful resuscitation attempt on one patient.

The lawyer asked, "So Doctor, do you consider yourself competent in resuscitating this particular patient? How do you know?"

He further questioned, "Does your day-to-day job prepare you to be competent at resuscitation, without being trained formally?"

Without formal training, I'd have difficulty answering. It is the same reason why we were asked to document procedures such as IJC insertion. Complications are sometimes unavoidable, but competency is a separate issue altogether.

3. Understand the importance of teamwork

If everybody is trained, each individual will know his/her role - whether to inform the 2-minute mark for rhythm analysis, or to swap roles after 2 minutes, or the importance of close-loop communication. And I think most importantly, is the role of team leader to oversee the resuscitation process.
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I really hope that local hospitals will make ACLS course readily available, with more affordable price. I don't think we need AHA certification for that. Training will ensure that we understand why amiodarone is needed in every resus trolley, so people are not rushing to get it from CCU/pharmacy in every VF/VT, losing precious time along the way.

Departments or hospitals should cover part of the cost, wherever possible, to make sure that the on-call doctors are competent and confident with their technique. Make it part of departmental KPI if we need to.

All the best!

https://eccguidelines.heart.org/…/cir…/cpr-ecc-guidelines-2/