2023 American Heart Association Focused Update on Adult Advanced Cardiovascular Life Support - Top 10 Take-Home Messages - Key Recommendations

Sep 23, 2026

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Cardiac arrest is common and deadly, affecting up to 700,000 people annually in the United States. The 2023 American Heart Association Focused Update on Adult Advanced Cardiovascular Life Support synthesizes current evidence and provides recommendations for medication use, temperature management, percutaneous coronary angiography, extracorporeal cardiopulmonary resuscitation, and seizure management. The update also addresses limits in recent literature for evaluating diversity, equity, and inclusion. It further highlights the cardiac arrest population as a potential source of organ donors awaiting transplantation.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages20

Reading Time50 min

AccessFree to download

Top 10 Take-Home Messages for the 2023 Focused Update on Adult Advanced Cardiovascular Life Support

Calcium administration guidance

Extracorporeal cardiopulmonary resuscitation use

Emergency coronary angiography strategy

Temperature control after return of spontaneous circulation

Temperature range and evidence limits for subgroups

Rewarming limits after spontaneous hypothermia

Antiseizure medication considerations

Downloaded from [http://ahajournals.org by on June 28](http://ahajournals.org by on June 28), 2024 Circulation AHA FOCUSED UPDATE | 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
Sarah M. Perman, MD, MSCE, FAHA, Vice Chair; Jonathan Elmer, MD, MS; Carolina B. Maciel, MD, MSCR; Anezi Uzendu, MD; Teresa May, DO; Bryn E. Mumma, MD, MAS; Jason A. Bartos, MD, PhD; Amber J. Rodriguez, PhD; Michael C. Kurz, MD, MS, FAHA; Ashish R. Panchal, MD, PhD; Jon C. Rittenberger, MD, MS, Chair; on behalf of the American Heart Association
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.
Key Words: AHA Scientific Statements ◼ advanced cardiac life support ◼ angiography ◼ heart arrest ◼ resuscitation | | | | --- | --- | --- | | TOP 10 TAKE-HOME MESSAGES FOR THE 2023 FOCUSED UPDATE ON ADULT ADVANCED CARDIOVASCULAR LIFE SUPPORT
1. It is important for researchers to develop and implement methods to improve representation of participants from diverse backgrounds and to improve the accuracy of reporting study subject demographics.
2. Routine administration of calcium for treatment of cardiac arrest is not recommended.
3. Use of extracorporeal cardiopulmonary resuscitation for patients with cardiac arrest refractory to standard advanced cardiovascular life support is reasonable in select patients when provided within an appropriately trained and equipped system of care. | 4. | Emergency coronary angiography is not recommended over a delayed or selective strategy in patients with return of spontaneous circulation after cardiac arrest unless they exhibit ST-segment–elevation myocardial infarction, shock, electrical instability, signs of significant myocardial damage, or ongoing ischemia. | | | 5. | We recommend that all adults who do not follow commands after return of spontaneous circulation, regardless of arrest location or presenting rhythm, receive treatment that includes a deliberate strategy for temperature control. | | | 6. | We recommend selecting and maintaining a con- | | | 7. | stant temperature between 32° C and 37.5° C during postarrest temperature control.
There is insufficient evidence to recommend a specific therapeutic temperature for different subgroups of patients with cardiac arrest. | Supplemental Material is available [at www.ahajournals.org/journal/doi/suppl/10.1161/CIR.0000000000001194](at www.ahajournals.org/journal/doi/suppl/10.1161/CIR.0000000000001194) . © 2023 American Heart Association, Inc. Circulation is available [at www.ahajournals.org/journal/circ](at www.ahajournals.org/journal/circ) e254 January 30, 2024 Circulation. 2024;149:e254–e273 . DOI: 10.1161/CIR.0000000000001194 Downloaded from [http://ahajournals.org by on June 28](http://ahajournals.org by on June 28), 2024 Perman et al Adult Advanced Cardiovascular Life Support | 8. | Patients with spontaneous hypothermia after return of spontaneous circulation who do not follow commands should not be routinely actively or passively rewarmed faster than 0.5° C per hour. | | --- | --- | | 9. | A thera

FAQs

Which medication approach is not recommended for routine cardiac arrest treatment?

Routine administration of calcium for treatment of cardiac arrest is not recommended.

When is extracorporeal cardiopulmonary resuscitation considered reasonable?

Extracorporeal cardiopulmonary resuscitation is reasonable in select patients with cardiac arrest refractory to standard advanced cardiovascular life support when delivered within an appropriately trained and equipped system of care.

How should coronary angiography timing be managed after return of spontaneous circulation?

Emergency coronary angiography is not recommended over a delayed or selective strategy unless patients have ST-segment–elevation myocardial infarction, shock, electrical instability, signs of significant myocardial damage, or ongoing ischemia.

Sep 23, 2026

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