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62(8): 390-403 [https://doi.org/10.11622/smedj.2021109](https://doi.org/10.11622/smedj.2021109)  \nCMEArticle  \nSingapore Advanced Cardiac Life Support Guidelines 2021  \nChi Keong Ching1, MBBS, MRCP, Benjamin Sieu-Hon Leong2, MBBS, MRCSEd, Praseetha Nair3, MBBS, MMed, Kim Chai Chan3, MBBS, FRCSEd (A&E), Eillyne Seow3, MBBS, FRCSEd (A&E), Francis Lee3, MBBS, FRCSEd (A&E), Kenneth Heng4, FRCS (A&E), MHPEd, Duu Wen Sewa5, MBBS, MRCP, Toon Wei Lim6, MBBS, PhD,  \nDaniel Thuan Tee Chong1, MBBS, MRCP, Khung Keong Yeo1, MBBS, Wee Kim Fong7, MBBS, MMed (Anaes), Venkataraman Anantharaman8, MBBS, FRCPEd, Swee Han Lim8, FRCSEd (A&E), FRCPEd  \n\n| ABSTRACT Advanced cardiac life support (ACLS) emphasises the use of advanced airway management and ventilation, circulatory support and the appropriate use of drugs in resuscitation, as well as the identification of reversible causes of cardiac arrest. Extracorporeal cardiopulmonary resuscitation and organ donation, as well as special circumstances including drowning, pulmonary embolism and pregnancy are addressed. Resuscitation does not end with ACLS but must continue in post-resuscitation care. ACLS also covers the recognition and management of unstable pre-arrest tachy-and bradydysrhythmias that may deteriorate further. |  |\n| --- | --- |\n| Keywords: advanced cardiac life support (ACLS), arrhythmias, defibrillation, resuscitation |  |\n| INTRODUCTION\u003Cbr>Advanced cardiac life support (ACLS) is the fourth link in the‘chain of survival’. Its success hinges on the optimal conduct of the previous three links: early access, early cardiopulmonary resuscitation (CPR) and early defibrillation. ACLS guidelines provide succinct arrhythmia management principles, interventions to optimise return of spontaneous circulation (ROSC) and evidence-based post-resuscitation interventions to enhance the chances of being discharged alive from the hospital with favourable neurological outcomes. The 2021 ACLS guidelines address the key components of this vital link and provide an update of the earlier guidelines that were published in 2017.(1)\u003Cbr>CARDIAC ARREST: EARLY RECOGNITION AND CALL FOR HELP\u003Cbr>Cardiac arrest may occur outside or inside the hospital, termed out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (IHCA), respectively. For OHCA, the emphasis is on early recognition by the public and access to emergency prehospital care, while close monitoring and early warning systems enable timely recognition of IHCA.\u003Cbr>OUT-OF-HOSPITAL CARDIAC ARREST AND PRE HOSPITAL RESPONSE\u003Cbr>Over the years, Singapore has made continuous improvements in the community, emergency medical services (EMS), hospitals and the integration in the chain of survival.(2) Prehospital emergency medical systems should provide telephone instructions for CPR;(3) activate community first responders; and rapidly dispatch basic cardiac life support (BCLS) and EMS first responders trained in the use of automatic external defibrillators (AEDs), high-performance | CPR teams(4) and paramedics to the scene as soon as possible (preferably within eight minutes) . (5) Optimisation of EMS asset deployment and stratified levels of responses for calls of different priority levels are important to ensure timely arrival. EMS interventions and protocols need to be regularly reviewed according to evidence. Transport to specialised cardiac arrest centres may also improve outcomes.(6)\u003Cbr>IN-HOSPITAL CARDIAC ARREST\u003Cbr>Hospitalised patients have a higher risk of deterioration that may progress to unrecognised cardiorespiratory arrest.(7) In addition, patients in cardiac arrest may be brought to or happen to be in public areas of the healthcare facilities. All staff from healthcare facilities should be educated to immediately recognise cardiac arrest and activate the emergency response system. Nonclinical staff are encouraged to be BCLS- and AED-certified, like any member of the public. All clinical staff are also be ","cbCaid8pKxS8YBUd","https://ap.wps.com/l/cbCaid8pKxS8YBUd","pdf",1345302,14,"English","# Introduction\n# Cardiac Arrest: Early Recognition and Call for Help\n# Out-of-Hospital Cardiac Arrest and Prehospital Response\n# In-Hospital Cardiac Arrest\n# Role of Rapid Response Teams","[{\"question\":\"What does ACLS primarily emphasize during resuscitation?\",\"answer\":\"ACLS emphasizes advanced airway management and ventilation, circulatory support, appropriate drug use, and identification of reversible causes of cardiac arrest.\"},{\"question\":\"How are out-of-hospital cardiac arrests expected to be handled in this guideline?\",\"answer\":\"The guideline highlights early public recognition, activation of emergency prehospital care, telephone instructions for CPR, rapid dispatch of first responders and EMS, and timely arrival (preferably within eight minutes).\"},{\"question\":\"What steps are recommended for in-hospital cardiac arrest recognition and response?\",\"answer\":\"All healthcare facility staff should be educated to recognize cardiac arrest and activate the emergency response system; clinical staff should be BCLS- and AED-certified unless excused for health reasons, and hospitals should use a universal system for activating standby certified teams and standardize equipment for rapid access.\"}]","Singapore Advanced Cardiac Life Support Guidelines 2021 | PDF",1790196858,35]