Advanced Cardiovascular Life Support (ACLS) is a critical certification for healthcare professionals who respond to life-threatening emergencies, particularly those involving cardiac arrest, stroke, and other cardiovascular complications.
While often associated with nurses and physicians, ACLS is highly relevant for respiratory therapists as well. Given their essential role in airway management, oxygenation, and ventilation during emergencies, respiratory therapists are frequently part of the code team and are expected to perform under pressure when every second counts.
In this article, we’ll explore why ACLS training is not only beneficial but often essential for respiratory therapists, and how it enhances both clinical skills and patient outcomes in high-stakes situations.
What is Advanced Cardiovascular Life Support (ACLS)?
Advanced Cardiovascular Life Support (ACLS) is a set of clinical protocols and interventions used to treat serious cardiovascular emergencies, such as cardiac arrest, stroke, and life-threatening arrhythmias. It builds on the foundation of Basic Life Support (BLS) by incorporating advanced airway management, the use of medications, interpretation of electrocardiograms (ECGs), and coordinated team-based resuscitation efforts.
ACLS is guided by evidence-based guidelines established by the American Heart Association (AHA) and is designed for healthcare providers who are involved in direct patient care. The training teaches how to recognize and respond to conditions like ventricular fibrillation, pulseless electrical activity (PEA), and asystole, using a systematic approach to assessment and intervention.
In essence, ACLS equips providers with the knowledge and skills to make split-second decisions that can mean the difference between life and death in critical situations.
Why ACLS is Important for Respiratory Therapists
Respiratory therapists play a vital role in emergency and critical care settings, where quick, coordinated action can save lives. ACLS certification is especially important for respiratory therapists because it enhances their ability to respond effectively during cardiovascular emergencies—situations they are often called to manage alongside doctors and nurses.
One of the key responsibilities of a respiratory therapist during a code blue or cardiac arrest scenario is to secure and manage the patient’s airway, provide effective ventilation, and assist with oxygenation. These tasks are foundational components of ACLS protocols. Understanding the full scope of ACLS procedures ensures that respiratory therapists can anticipate the needs of the team, communicate clearly, and deliver appropriate interventions without hesitation.
In many hospitals, respiratory therapists are expected to be active members of the resuscitation team. ACLS training empowers them with the knowledge to recognize life-threatening rhythms on a monitor, understand the rationale behind medication choices, and follow the algorithm-based approach to patient care. It also promotes better collaboration and confidence when working in high-pressure environments.
Ultimately, ACLS certification doesn’t just enhance a respiratory therapist’s skill set—it elevates their role as a critical, knowledgeable contributor during medical emergencies. It prepares them to act quickly, efficiently, and in alignment with the rest of the care team, improving patient outcomes when every second matters.
ACLS Practice Questions
1. In which situation does bradycardia require immediate treatment?
Hypotension
2. Which intervention is most appropriate for treating a patient in asystole?
Epinephrine
3. A patient is in asystole after an AED advised “no shock indicated.” CPR has resumed. What is the next step?
Establish IV or IO access
4. A patient in the ICU develops sudden narrow-complex tachycardia at 220/min. BP is 128/58 mm Hg. Vagal maneuvers fail. What should you do next?
Administer adenosine 6 mg IV push
5. A patient with bradycardia (36/min) is confused, BP is 88/56 mm Hg. Atropine and pacing failed. What’s next?
Epinephrine 2 to 10 mcg/min
6. A patient in cardiac arrest has persistent ventricular fibrillation after a second shock. What is the first drug to give?
Epinephrine 1 mg IV/IO
7. A stroke patient meets criteria for fibrinolysis and is receiving rtPA. What should you do regarding aspirin?
Hold aspirin for at least 24 hours
8. After initial amiodarone 300 mg IV push for refractory VF, what is the second dose?
Amiodarone 150 mg IV push
9. What is the initial atropine dose for symptomatic bradycardia?
0.5 mg IV
10. A patient with SVT at 180/min doesn’t respond to vagal maneuvers. What is your next intervention?
Adenosine 6 mg IV push
11. In cardiac arrest without IV access, what’s the preferred route for drug administration?
IV or IO
12. What is the indication for magnesium in cardiac arrest?
Torsades de Pointes with pulseless ventricular tachycardia
13. A stable patient has wide-complex irregular tachycardia at 138/min and a history of angina. What should you do next?
Seek expert consultation
14. A patient is in asystole. High-quality CPR is in progress. What is the first drug to give?
Epinephrine 1 mg IV/IO
15. A patient with refractory VF received epinephrine and amiodarone. What should the team leader order next?
Epinephrine 1 mg
16. What is a contraindication for nitrate use in a patient with chest discomfort?
Recent use of phosphodiesterase inhibitors
17. A patient with wide-QRS tachycardia becomes diaphoretic and hypotensive. What’s the next step?
Synchronized cardioversion
18. A STEMI patient on heparin has not taken aspirin due to past gastritis. What should you do next?
Administer 160–325 mg aspirin to chew
19. A stroke patient had an intracerebral hemorrhage 2 months ago. CT is negative for new bleeding. What drug is appropriate?
Aspirin
20. A patient in pulseless VT received epinephrine and shocks. What is the next drug?
Amiodarone 300 mg IV push
21. What is the maximum time allowed for interruption of chest compressions?
10 seconds
22. A hypotensive, pale, and diaphoretic patient has sinus bradycardia. What do you give next?
Atropine 0.5 mg IV
23. A woman with palpitations and narrow-complex tachycardia is stable. What is the first intervention?
Vagal maneuvers
24. After an AED delivers a shock, what should be done immediately?
Resume chest compressions
25. What technique reduces the risk of gastric inflation during bag-mask ventilation?
Ventilate until visible chest rise is seen
26. You find an unresponsive patient who is not breathing. After activating the emergency response system, you determine there is no pulse. What is your next action?
Start chest compressions at a rate of 100–120 per minute.
27. You are evaluating a 58-year-old man with chest pain. His blood pressure is 92/50 mm Hg, heart rate is 92/min, respiratory rate is 14/min, and SpO2 is 97%. What is the most important next step in assessment?
Obtain a 12-lead ECG.
28. What is the preferred method for administering epinephrine during cardiac arrest?
Peripheral IV access.
29. An AED does not promptly analyze the rhythm. What is your next action?
Begin chest compressions immediately.
30. What is a common but potentially fatal mistake during cardiac arrest management?
Allowing prolonged interruptions in chest compressions.
31. Which action is a key component of high-quality chest compressions?
Allow complete chest recoil after each compression.
32. Which action increases the likelihood of successful defibrillation in ventricular fibrillation?
Delivering high-quality chest compressions before attempting defibrillation.
33. Which situation best describes pulseless electrical activity (PEA)?
An organized rhythm on the monitor without a palpable pulse.
34. What is the best strategy for providing CPR to a patient with an advanced airway in place?
Give continuous chest compressions and 1 ventilation every 6 seconds.
35. After inserting an endotracheal tube and performing continuous chest compressions, the capnography shows a PETCO₂ of 8 mm Hg. What does this indicate?
Chest compressions may be inadequate.
36. What is the value of quantitative capnography in intubated patients during CPR?
It provides a reliable indicator of CPR quality.
37. After 25 minutes of unsuccessful resuscitation with asystole on the monitor and no ROSC, what is your next step?
Consider termination of efforts after consulting medical control.
38. Which safety measure should be followed during defibrillation?
Ensure oxygen is not blowing over the patient’s chest during shock delivery.
39. You find an unconscious, apneic patient and cannot determine a pulse. What should you do next?
Start high-quality chest compressions.
40. What is an advantage of using hands-free defibrillator pads?
They allow faster and safer defibrillation.
41. What action is recommended to minimize interruptions in compressions during CPR?
Continue compressions while the defibrillator charges.
42. Which of the following is part of the BLS survey?
Early defibrillation when indicated.
43. What is the recommended initial dose of amiodarone for refractory ventricular fibrillation?
300 mg IV push.
44. What is the maximum recommended interruption time for chest compressions?
No more than 10 seconds.
45. What PETCO₂ value is a sign of effective chest compressions?
10 mm Hg or greater.
46. What is the main purpose of a Medical Emergency Team (MET) or Rapid Response Team (RRT)?
To identify and treat early signs of clinical deterioration.
47. Which action improves the effectiveness of compressions during resuscitation?
Rotate compressors every 2 minutes or 5 cycles.
48. What is the correct ventilation rate for an adult in respiratory arrest with a pulse?
1 breath every 5–6 seconds (10–12 per minute).
49. A patient presents with bradycardia, hypotension, and dizziness. What is the first-line drug and dose?
Atropine 0.5 mg IV.
50. A bradycardic patient has not responded to atropine and no pacemaker is available. What is the appropriate dopamine dose?
2 to 10 mcg/kg per minute IV infusion.
51. When do you first introduce drug therapy in cardiac arrest, and which medication is used?
After the second shock, administer epinephrine 1 mg IV/IO every 3–5 minutes.
52. When is amiodarone introduced during cardiac arrest?
After the third shock, give 300 mg IV bolus. If needed, follow with a second dose of 150 mg.
53. What are the shockable rhythms during cardiac arrest?
Ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT).
54. What are the non-shockable rhythms in cardiac arrest?
Asystole and pulseless electrical activity (PEA).
55. In a cardiac arrest with a non-shockable rhythm, when should epinephrine be administered?
After the first cycle of CPR, give epinephrine 1 mg IV/IO every 3–5 minutes.
56. What steps should be taken after return of spontaneous circulation (ROSC)?
Maintain oxygen saturation ≥94%, treat hypotension with fluids or vasopressors, obtain a 12-lead ECG, consider targeted temperature management if comatose, and consider reperfusion if EKG indicates STEMI or AMI.
57. What are the 5 H’s and 5 T’s in ACLS reversible causes?
Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo/hyperkalemia, Hypothermia; Tension pneumothorax, Tamponade (cardiac), Toxins, Thrombosis (pulmonary), Thrombosis (coronary).
58. How is non-symptomatic bradycardia treated?
Monitor and observe without immediate drug therapy.
59. What defines symptomatic bradycardia?
Hypotension, altered mental status, signs of shock, chest pain, or acute heart failure.
60. How is symptomatic bradycardia treated?
Start with atropine 0.5 mg IV every 3–5 minutes (max 3 mg). If ineffective, use transcutaneous pacing, dopamine infusion 2–10 mcg/kg/min, or epinephrine infusion 2–10 mcg/min.
61. What element of a system of care is represented by properly functioning resuscitation equipment?
Structure
62. What is the first link in the out-of-hospital cardiac arrest (OHCA) chain of survival?
Activation of the emergency response system
63. What are signs of clinical deterioration that would prompt activation of the rapid response system?
Symptomatic hypertension, seizure, and unexplained agitation
64. What is the primary purpose of a rapid response team (RRT) or medical emergency team (MET)?
To improve patient outcomes by identifying and treating early signs of clinical deterioration
65. What happens when teams promptly assess and intervene in patients with abnormal vital signs?
The number of in-hospital cardiac arrests (IHCAs) is reduced
66. What are the additional benefits of implementing a rapid response system?
Decreased ICU length of stay, reduced total hospital length of stay
67. What is the main advantage of effective teamwork in resuscitation?
Division of responsibilities to increase efficiency
68. What is the best example of a team leader’s role?
Modeling effective team behavior and assigning roles
69. What is the best example of a team member’s role?
Being prepared to carry out their assigned responsibilities
70. What is the primary purpose of the CPR coach on a resuscitation team?
To enhance the quality of chest compressions during CPR
71. What are the six essential roles in a high-performance resuscitation team?
Team leader, airway manager, timer/recorder, compressor (switch every 2 min), monitor/defibrillator/CPR coach, IV/IO/medication provider
72. Who is responsible for assigning roles within a high-performance team?
The team leader
73. Which member of the high-performance team is part of the resuscitation triangle?
The monitor/defibrillator/CPR coach
74. What is an example of knowledge sharing by a team leader?
Asking team members for input on clinical decisions or interventions
75. What is an example of summarizing and reevaluating during resuscitation?
Increasing patient monitoring when the condition worsens
76. What is a key component of closed-loop communication?
Confirming task completion before assigning the next task
77. What are examples of mutual respect during resuscitation?
Acknowledging properly completed tasks positively, ensuring only one person speaks at a time
78. What are the core components of high-quality CPR?
Compression depth of at least 2 inches (5 cm), switching compressors every 2 minutes, avoiding excessive ventilation, full chest recoil, and limiting interruptions to under 10 seconds
79. How do you calculate chest compression fraction (CCF), and what is the ideal target?
Divide chest compression time by total resuscitation time; target at least 60%, ideally over 80%
80. What component of high-performance teams is represented by the use of real-time feedback devices during CPR?
Quality improvement and performance monitoring
81. How is Coronary Perfusion Pressure (CPP) calculated?
CPP = Aortic diastolic pressure – Right atrial diastolic pressure
82. How do interruptions in chest compressions affect survival after cardiac arrest?
They lower coronary perfusion pressure, decreasing the likelihood of successful resuscitation
83. What is the only intervention proven to restore an organized rhythm in patients with ventricular fibrillation?
Early and effective defibrillation
84. What is the recommended time frame for performing a non-contrast head CT in a suspected stroke patient?
Within 25 minutes of hospital arrival
85. What PETCO2 reading during CPR suggests that chest compressions may be inadequate?
Less than 10 mm Hg
86. When caring for a post-cardiac arrest patient, what SpO2 range should be maintained?
94% to 99%
87. What action should be taken immediately after a shock is delivered during CPR?
Resume chest compressions without delay
88. What is the goal “door-to-balloon” time for PCI in STEMI patients?
Within 90 minutes of hospital arrival
89. What is the target blood glucose range for post-cardiac arrest patients?
140 to 180 mg/dL
90. In adult cardiac arrest, how often should epinephrine be administered?
1 mg IV/IO every 3 to 5 minutes
91. What is the minimum recommended temperature for targeted temperature management in post-ROSC care?
32°C (89.6°F)
92. What is the maximum recommended temperature for targeted temperature management in post-ROSC care?
36°C (96.8°F)
93. What type of defibrillation shock is recommended for biphasic defibrillators?
Manufacturer’s recommended dose (e.g., 120-200 joules)
94. What should be done before analyzing a rhythm with an AED?
Ensure no one is touching the patient
95. What is the ideal compression-to-ventilation ratio for adult CPR without an advanced airway?
30 compressions to 2 breaths
96. What are the signs that a stroke patient is not a candidate for fibrinolytic therapy?
Recent head trauma, active bleeding, or known intracranial hemorrhage
97. What is the role of glycoprotein IIb/IIIa inhibitors in ACS?
They prevent platelet aggregation during PCI
98. What heart rate threshold defines bradycardia in ACLS?
Less than 50 beats per minute
99. What type of rhythm should be confirmed before attempting defibrillation?
Pulseless ventricular tachycardia or ventricular fibrillation
100. What is the primary goal of post-cardiac arrest care?
Optimize oxygenation, ventilation, and perfusion to prevent further injury
Final Thoughts
ACLS certification is more than just a professional credential for respiratory therapists—it’s a vital component of delivering high-quality, lifesaving care.
As frontline providers in emergency situations, respiratory therapists must be equipped with the knowledge, skills, and confidence to act quickly and effectively during cardiovascular crises.
By understanding ACLS protocols and integrating them into their practice, respiratory therapists can enhance patient outcomes, improve team coordination, and play a critical role in resuscitation efforts. In today’s fast-paced healthcare environment, being ACLS-certified isn’t just recommended—it’s essential.
Written by:
John Landry is a registered respiratory therapist from Memphis, TN, and has a bachelor's degree in kinesiology. He enjoys using evidence-based research to help others breathe easier and live a healthier life.
References
- Perman SM, Elmer J, Maciel CB, Uzendu A, May T, Mumma BE, Bartos JA, Rodriguez AJ, Kurz MC, Panchal AR, Rittenberger JC; 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. 2024.