Cardiovascular life support is a critical component of emergency medical care that encompasses a range of interventions aimed at stabilizing patients experiencing cardiac or respiratory emergencies.
As cardiovascular diseases remain a leading cause of death globally, understanding and effectively implementing these protocols can mean the difference between life and death.
This article aims to dissect key elements of cardiovascular life support, including techniques, guidelines, and the latest research that informs best practices in the field.
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What is Cardiovascular Life Support?
Cardiovascular life support is a medical intervention focused on providing urgent care to individuals facing life-threatening cardiac emergencies like cardiac arrest or severe arrhythmias. It involves a range of procedures, including advanced cardiac monitoring, pharmacotherapy, and mechanical interventions, to restore and maintain heart function.
Types of Cardiovascular Life Support
Cardiovascular life support can be categorized based on the level of complexity and the setting in which it is applied. Here are some of the primary types:
- Basic Life Support (BLS)
- Advanced Cardiac Life Support (ACLS)
- Pediatric Advanced Life Support (PALS)
Basic Life Support
Basic Life Support (BLS) is the foundational level of cardiovascular life support aimed at maintaining adequate circulation and ventilation until advanced care arrives.
BLS protocols are designed for rapid implementation and can be executed by both healthcare providers and laypeople.
Key components include chest compressions, rescue breathing, and the use of automated external defibrillators (AEDs).
BLS serves as the first line of response in cardiac emergencies and is essential for buying time until more specialized treatment can be administered.
Advanced Cardiac Life Support
Advanced Cardiac Life Support (ACLS) is a comprehensive, protocol-driven approach to treating severe cardiovascular emergencies like cardiac arrest, unstable angina, and acute myocardial infarction.
Administered by trained healthcare professionals, ACLS includes advanced interventions such as rhythm analysis, defibrillation, intravenous drug administration, and endotracheal intubation.
ACLS takes over where BLS leaves off, offering a more specialized set of treatments aimed at rapidly stabilizing the patient’s condition and preventing further cardiac events.
Pediatric Advanced Life Support
Pediatric Advanced Life Support (PALS) is a specialized version of ACLS tailored for infants and children up to the age of 18.
PALS incorporates age-specific guidelines and treatment algorithms to address the unique physiological characteristics and needs of this population.
Procedures may include advanced airway management, intravenous fluid resuscitation, and the use of medications adapted for pediatric use.
PALS is vital for healthcare providers who work in settings like pediatric emergency departments, intensive care units, and any scenario where children may require advanced resuscitative measures.
Cardiovascular Life Support Practice Questions
1. Do respiratory therapists play a vital role in emergency cardiovascular life support?
Yes, respiratory therapists play an essential role in this process.
2. What is the goal of basic life support?
The goal of basic life support (BLS) is to restore ventilation and circulation to victims of airway obstruction and respiratory or cardiac arrest.
3. What is CPR?
Cardiopulmonary resuscitation (CPR) is a basic emergency procedure for life support, consisting of assisted respiration and manual external cardiac compressions.
4. What is the most common cause of sudden death in adults?
Coronary artery disease
5. What is a complication associated with abdominal thrusts?
6. During CPR, how many compressions and breaths should you give?
Five cycles of 30 compressions to 2 ventilations
7. Evaluating the effectiveness of CPR is important and requires rescuers to watch for what?
Visible chest rise and fall durings ventilations and hard/fast chest compressions.
8. What are the complications of CPR?
Worsening of potential neck injuries, gastric inflation and vomiting, and internal trauma during chest compressions.
9. A respiratory therapist is most known for doing what during CPR?
They are most known for establishing an airway and providing ventilations.
10. What pharmacologic agents are commonly used during ACLS?
Atropine for bradycardia, epinephrine and amiodarone or lidocaine for ventricular arrhythmias, and epinephrine or vasopressin for cardiac arrest and hypotension.
11. In the post-resuscitative phase, a respiratory therapist may need to do what?
Help maintain normal ventilation and oxygenation while assisting the physician and nurses in monitoring the patient’s condition.
12. Respiratory therapists are often involved in the care of cardiac arrest victims who do what?
Responds favorably to CPR
13. What is an abdominal thrust?
A maneuver where external pressure is forcefully exerted on the abdomen and under the diaphragm to expel obstructing objects from the upper airway
14. What is ACLS?
It stands for Advanced Cardiac Life Support and includes emergency medical procedures beyond basic life support; including intravenous fluids, possible defibrillation, drug administration, control of cardiac arrhythmias, and the use of ventilation equipment.
15. Why are chest compressions performed?
To provide adequate circulation
16. How are chest compressions performed?
They are performed by compressing the sternum 2 inches at a rate of 100 compressions per minute. If there is an interruption, resume quickly.
17. What is an AED?
A portable automatic device to perform defibrillation on patients outside the hospital.
18. An AED is indicated for which cardiac rhythms?
VF and VT
19. What is BLS?
Cardiopulmonary resuscitation designed to re-institute either circulatory or respiratory function without equipment or drugs.
20. What is CABD of resuscitation?
Circulation, airway, breathing, and defibrillation.
21. How does cardiac output from compressions compare to normal cardiac output?
It is about one-fourth of the normal output during compressions.
22. When is cardioversion used?
It is used in atrial fibrillation, defibrillation is done on the R-wave.
23. What is the most common and one of the most useful types of monitoring used during ACLS?
24. What is defibrillation used for?
It is used for the termination of ventricular fibrillation by delivering a direct counter-shock to the patient’s precordium.
25. During the resuscitation of a victim in cardiac arrest, how many breaths should be given over what period of time?
2 breaths should be given over 1 second.
26. Electrical shock can cause what?
Cardiac or respiratory arrest
27. Exhaled air provides what percentage of oxygen?
28. What is gastric inflation?
It is the introduction of air into the stomach and intestine and is caused by prolonged mouth-to-mouth.
29. Healthcare providers should use what ratio for adults and children during CPR?
30:2, compressions to ventilations.
30. Healthcare providers should use a ratio of what for infants during CPR?
3:1, compressions to ventilations (2 rescuers).
31. What is the primary procedure recommended when spinal trauma is not suspected?
The head-tilt/chin-lift technique
32. What are some considerations for performing infant compressions?
Use the lower half of the sternum, place index finger at the nipple line, then the middle and ring fingers are used for the compressions, use the other hand to maintain the head position, compress 1.5 inches at 100/minute.
33. In general, how should you give compressions to an adult?
Hard and fast
34. What are the most effective instructions for giving CPR?
Give 100 compressions per minute and a depth of 2 inches, allow the chest to recoil, and minimize interruptions.
35. What is the universal distress signal for foreign body obstruction?
Clutching the throat
36. What should you do if the patient has a pulse but is not breathing?
Start ventilations immediately; 8-10 breaths/minute.
37. Providing artificial ventilations must take place how quickly to prevent biological death?
Within 4-6 minutes.
38. When should pulse and rhythm checks after the shock be performed?
After 5 cycles of CPR have been completed.
39. What are pulseless ventricular rhythms?
They are the first manifestation of cardiac arrest in 25% of cases.
40. How to restore the airway?
Inspect for a neck/facial injury, move the victim to the supine position; the movement of lower jaw and extension of the neck pulls the tongue out of the way; perform head-tilt chin-lift, and jaw thrusts.
41. What should be used when neck injuries are suspected and only done by trained clinicians?
The jaw thrust
42. What is the leading cause of death in the United States?
Sudden cardiac arrest
43. What are the steps for administering BLS as a single practitioner?
(1) Check for lack of movement, response, and abnormal breathing or gasping. (2) If no response, check for a pulse within 10 seconds. (3) Activate the emergency response system. (4) If no AED, start compressions and rescue breathing at a ratio of 30:2 for adult cardiac arrest. (5) Open the airway and check breathing. (6) If the patient is not breathing, give 2 breaths that can produce a rise of the chest and resume compressions. (7) When an AED arrives with the response team, perform a shock.
44. What is synchronized cardioversion?
A counter-shock synchronized with the heart’s electrical activity.
45. When do you stop ALS?
When there is a spontaneous pulse and breathing, pronounced death by the doctor, or if the patient has a DNR status.
46. When is mouth-to-nose ventilation used?
Trismus (involuntary contraction of the jaw muscles-lock jaw), traumatic jaw, mouth injury, or if the mouth seal is difficult to maintain.
47. When should you start to use chest compressions on a neonate?
If the heart rate decreases to less than 60 beats per minute despite adequate ventilation with 100% oxygen.
48. With two rescuers, how often should you switch positions?
Every 5 cycles, or about every 2 minutes.
49. How is an advanced airway helpful?
Advanced airways help deliver ventilations that are nonsynchronous with chest compressions, restore airway patency, maintain adequate ventilation, isolate and protect the airway from aspiration, provide access for clearance of secretions, and provide an alternate route for administration of selected drugs.
50. As long as air exchange is present, the patient should be reassured and allowed to clear his or her own airway by doing what?
51. Assuming mouth-to-mouth ventilation is successful, and the patient remains apneic, you should continue the effort at what pace?
At a rate of one breath every 5–6 seconds to maintain a minimal adult rate of 10 to 12 breaths/minute.
52. Cardioversion is similar to defibrillation with what two exceptions?
Countershock is synchronized with the heart’s electrical activity (the R wave). The energy used during cardioversion usually is less than that applied during defibrillation.
53. Chest compressions for a neonate are indicated when?
If the heart rate falls below 60 beats/min or remains between 60 and 80 beats/min despite adequate ventilation with 100% oxygen for 30 seconds.
54. What is defibrillation?
An unsynchronized shock used to simultaneously depolarize the myocardial fibers
55. How are drugs administered during CPR?
By rapid bolus injection
56. During respiratory arrest, the victim must be provided oxygen within?
Within 4 to 6 min or biological death will follow
57. Exhaled air provides what?
It provides approximately 16% oxygen, which is sufficient to achieve an arterial oxygen tension of 50 to 60 mmHg.
58. What is the goal of BLS?
To restore ventilation and circulation
59. If an adult victim with FABO becomes unresponsive, the rescuer should do what?
Move the patient to the ground, activate the EMS system, and begin CPR.
60. In adults, how far should you compress the sternum?
1.5 to 2 inches
61. In an adult, chest compressions should be done how?
They should be done on the lower half of the sternum at a rate of 100 compressions/minute.
62. In infants and children, two rescuers should use a compression/ventilation ratio of what?
63. What is the most common cause of airway obstruction?
Loss of muscle tone, which causes the tongue to fall back into the pharynx.
64. Neonatal chest compressions are given at a depth of?
Approximately one-third of the anteroposterior diameter of the chest.
65. Pharyngeal airways restore airway patency by?
By separating the tongue from the posterior pharyngeal wall.
66. What is the ratio between downstroke/upstroke?
67. Rescue attempts continue until when?
Advanced life support is available, the rescuers note spontaneous pulse and breathing, or a physician pronounces the victim dead.
68. What are the three steps for administering BLS?
(1) Check for movement or response, (2) Activate emergency medical services, and (3) if no response, check pulse within 10 seconds.
69. What four drugs may be given through the ET tube?
Epinephrine, Lidocaine, Atropine, and Narcan.
70. What artery should be used to evaluate pulselessness?
In adults, you should use the carotid; In infants, you should use the brachial.
Cardiovascular life support remains an indispensable part of emergency medical care, and its effective implementation is crucial for maximizing patient survival and long-term outcomes.
While preventive measures and early intervention are always preferable, the immediacy and severity of cardiac emergencies often make cardiovascular life support the difference between life and death.
Current best practices incorporate a multifaceted approach that includes advanced monitoring, drug therapy, and mechanical interventions.
As our understanding of cardiac emergencies continues to evolve, it is imperative for healthcare professionals to stay updated on the latest guidelines and technologies to offer the highest standard of care.
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.
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