/policies/,/policies/clinical/,/policies/clinical/uw-health-clinical/,/policies/clinical/uw-health-clinical/emergency-response/,

/policies/clinical/uw-health-clinical/emergency-response/5113.policy

201605138

page

100

UWHC,UWMF,

Policies,Clinical,UW Health Clinical,Emergency Response/Management

Defibrillation by BLS/ACLS/PALS Trained and Qualified Nurses and Clinical Exercise Physiologists (5.1.13)

Defibrillation by BLS/ACLS/PALS Trained and Qualified Nurses and Clinical Exercise Physiologists (5.1.13) - Policies, Clinical, UW Health Clinical, Emergency Response/Management

5.1.13


UW HEALTH CLINICAL POLICY 1
Policy Title: Defibrillation by BLS/ACLS/PALS Trained and Qualified Nurses and
Clinical Exercise Physiologists
Policy Number: 5.1.13
Category: UW Health
Type: Ambulatory and Inpatient
Effective Date: May 13, 2013

I. PURPOSE

To outline the role of the American Heart Association (AHA) trained and qualif ied Advanced Cardiac Life
Support, Basic Life Support, Pediatric Advanced Life Support registered nurse and clinical exercise
physiologist in an emergency situation requiring defibrillation.

II. DEFINITIONS

A. Basic Life Support (BLS): This course is designed to provide a w ide variety of healthcare professionals the
ability to recognize several life-threatening emergencies, provide CPR, use an AED, and relieve choking in a
safe, timely and effective manner.
http://cpr.heart.org/AHAECC/CPRAndECC/Training/HealthcareProfessional/BasicLifeSupportBLS/UCM_473
189_Basic-Life-Support-BLS.jsp
B. Advanced Cardiac Life Support (ACLS): This course is an advanced, instructor-led classroom course that
highlights the importance of team dynamics and communication, systems of care and immediate post-
cardiac-arrest care. It also covers airw ay management and related pharmacology.
http://cpr.heart.org/AHAECC/CPRAndECC/Training/HealthcareProfessional/AdvancedCardiovascularLifeSu
pportACLS/UCM_473186_Advanced-Cardiovascular-Life-Support-ACLS.jsp
C. Pediatric Advanced Life Support (PALS): classroom, video-based, Instructor-led course that uses a series
of simulated pediatric emergencies to reinforce the important concepts of a systematic approach to pediatric
assessment, basic life support, PALS treatment algorithms, effective resuscitation and team dynamics.
http://cpr.heart.org/AHAECC/CPRAndECC/Training/HealthcareProfessional/Pediatric/UCM_473190_Pediatr i
c.jsp
D. Automated External Defibrillator (AED): is a portable device that analyzes the heart rhythm and can send an
electric shock to the heart to try to restore a normal rhythm. AEDs are used to treat sudden cardiac arrest
(SCA).
https://w ww.nhlbi.nih.gov/health/health-topics/topics/aed

III. POLICY ELEMENTS

BLS trained and qualif ied staff: In the absence of a physician, BLS trained and qualif ied staff w ho have
demonstrated competency in the use of the automatic external defibrillator during orientation and/or annual
review , should upon recognizing an emergency, perform artif icial ventilation and circulation; institute AED for
treatment of potentially fatal ventricular arrhythmias.

ACLS/PALS trained and qualif ied staff: Nurses and clinical exercise physiologists may follow guidelines
established by AHA regarding manual defibrillation. Focus w ill continue on earliest possible defibrillation and
supporting chest compressions w ith minimal interruption throughout the resuscitative effort. The ACLS
trained and qualif ied staff should use the anterior-anterior placement of the defibrillation pads.

For the postoperative cardiac surgery patient, ACLS certif ied nurses can follow population specif ic algorithm
and postoperative orders.

IV. PROCEDURE

A. In the event of an emergency, the BLS staff member may initiate manual AED follow ing BLS protocols
w ithout a previous order from the physician. The BLS staff may continue to defibrillate based on the AED
recommendations or until the physician arrives.
ξ For Heartstream AED:
http://w w w.usa.philips.com/healthcare/solutions/emergency-care-resuscitation/automated-external-
defibrillators
ξ For Zoll defibrillators :
http://w w w.zoll.com/medical-products/product-manuals/



UW HEALTH CLINICAL POLICY 2
Policy Title: Defibrillation by BLS/ACLS/PALS Trained and Qualif ied Nurses and Clinical Exercise Physiologists
Policy Number: 5.1.13

ξ For LifePak 12:
http://w w w.physio-
control.com/uploadedFiles/products/defibrillators/product_data/operational_manuals/LIFEPAK12_O
peratingInstructions_3207254-008.pdf
B. For ACLS/PALS trained and qualif ied staff, they may initiate and continue manual defibrillation follow ing
ACLS/PALS American Heart Association algorithms.
ξ Zoll Defibrillator Reference Links :
o BLS:
http://w w w.heart.org/HEARTORG/CPRAndECC/HealthcareTraining/BasicLifeSupportBLS/
Basic-Life-Support-BLS_UCM_001281_SubHomePage.jsp
o ACLS:
w ww.heart.org/HEARTORG/CPRAndECC/HealthcareTraining/AdvancedCardiovascularLif
eSupportACLS/Advanced-Cardiovascular-Life-Support-
ACLS_UCM_001280_SubHomePage.jsp
o PALS:
http://w w w.heart.org/HEARTORG/CPRAndECC/HealthcareTraining/Pediatr ics/Pediatric -
Advanced-Life-Support-PALS_UCM_303705_Article.jsp
ξ Life Pak 12 Reference Links:
o BLS:
http://w w w.heart.org/HEARTORG/CPRAndECC/HealthcareTraining/BasicLifeSupportBLS/
Basic-Life-Support-BLS_UCM_001281_SubHomePage.jsp
o ACLS:
w ww.heart.org/HEARTORG/CPRAndECC/HealthcareTraining/AdvancedCardiovascularLif
eSupportACLS/Advanced-Cardiovascular-Life-Support-
ACLS_UCM_001280_SubHomePage.jsp
o PALS:
http://w w w.heart.org/HEARTORG/CPRAndECC/HealthcareTraining/Pediatr ics/Pediatric -
Advanced-Life-Support-PALS_UCM_303705_Article.jsp

C. For left ventricular assist device patients, defibrillation is acceptable but no chest compressions are
recommended.
D. For adult postoperative cardiac surgery and heart transplant patients only cared for by ACLS certif ied
nurses:
i. Unw itnessed ventricular f ibrillation or pulseless ventricular tachycardia, follow ACLS protocol.
ii. Witnessed ventricular f ibrillation or pulseless ventricular tachycardia follow the resuscitation orders
on the postoperative cardiac surgery and heart transplant order sets.
iii. Asystole/severe bradycardia or pulseless electrical activity tachycardia follow the resuscitation
orders on the postoperative cardiac surgery and heart transplant order sets.
iv. Epinephrine dosing is to be ordered by the attending physician due to risk of hypertension,
tachycardia and ischemia.
v. Refer to Appendix A, Cardiac Surgery/Heart Transplant Post Resuscitation Algorithm.
vi. Patients w ith an open chest requiring internal defibrillation w ill require a physician to perform the
defibrillation.

V. FORMS

Resuscitation Record

VI. COORDINATION

Author: Director, Heart, Vascular and Thoracic Services
Senior Management Sponsor: SVP, Patient Care Services and CNO
Approval committees: Resuscitation Review Committee; UW Health Clinical Policy Committee
UW Health Clinical Policy Committee Approval: April 18, 2016

UW Health is a cohesive, united and integrated academic medical enterprise comprised of several entities.
This policy applies to facilities and programs operated by the University of Wisconsin Hospitals and Clinics
and the University of Wisconsin Medical Foundation, Inc., and to clinical facilities and programs



UW HEALTH CLINICAL POLICY 3
Policy Title: Defibrillation by BLS/ACLS/PALS Trained and Qualif ied Nurses and Clinical Exercise Physiologists
Policy Number: 5.1.13

administered by the University of Wisconsin School of Medicine and Public Health. Each entity is
responsible for enforcement of this policy in relation to the facilities and programs that it operates.

VII. APPROVAL

Peter New comer, MD
UW Health Chief Medical Officer

J. Scott McMurray, MD
Chair, UW Health Clinical Policy Committee

VIII. Reference Links:

A. Defibrillators:
ξ AED:
http://w w w.usa.philips.com/healthcare/solutions/emergency-care-resuscitation/automated-external-
defibrillators
ξ Zoll Defibrillators:
http://w w w.zoll.com/medical-products/product-manuals/
ξ LifePak 12:
http://w w w.physio-
control.com/uploadedFiles/products/defibrillators/product_data/operationa l_manuals/LIFEPAK12_O
peratingInstructions_3207254-008.pdf
B. American Heart Association Certif ication
ξ BLS:
http://w w w.heart.org/HEARTORG/CPRAndECC/HealthcareTraining/BasicLifeSupportBLS/Basic -
Life-Support-BLS_UCM_001281_SubHomePage.jsp
ξ ACLS:
w ww.heart.org/HEARTORG/CPRAndECC/HealthcareTraining/AdvancedCardiovascularLifeSupport
ACLS/Advanced-Cardiovascular-Life-Support-ACLS_UCM_001280_SubHomePage.jsp
ξ PALS:
http://w w w.heart.org/HEARTORG/CPRAndECC/HealthcareTraining/Pediatr ics/Pediatric -Advanced-
Life-Support-PALS_UCM_303705_Article.jsp


IX. REFERENCES

Berg MD, Schexnayder SM, Chameides L et al. Part 13: pediatric basic life support: 2010 American Heart
Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation.
2010;122(18suppl3):S862-875.

Callaw ay CW, Donnino MW, Fink EL et al. Part 8: post-cardiac arrest care: 2015 American Heart
Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care.
Circulation. 2015;132(18suppl2):S465-482.

De Caen AR, Berg MD, Chameides L et al. Part 12: pediatric advanced life support: 2015 American Heart
Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care.
Circulation. 2015;132(18suppl2):S526-542.

Dunning J, Fabbri A, Kolh PH et al. Guideline for resuscitation in cardiac arrest after cardiac surgery. Eur J
Cardiothorac Surg. 2009;36(1):3-28.

Field JM, Hazinski MF, Sayre MR et al. Part 1: executive summary: 2010 American Heart Association
guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation.
2010;122(18suppl3):S640-656.

Kleinman ME, Brennan EE, Goldberger ZD et al. Part 5: adult basic life support and cardiopulmonary
resuscitation quality: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation



UW HEALTH CLINICAL POLICY 4
Policy Title: Defibrillation by BLS/ACLS/PALS Trained and Qualif ied Nurses and Clinical Exercise Physiologists
Policy Number: 5.1.13

and emergency cardiovascular care. Circulation. 2015;132(18suppl2):S414-435.

Kleinman ME, Chameides L, Schexnayder SM et al. Part 14: pediatric advanced life support: 2010 American
Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care.
Circulation. 2010;122(18suppl3):S876-908.

Lavonas EJ, Drennan IR, Gabrielli A et al. Part 10: special circumstances of resuscitation: 2015 American
Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care.
Circulation. 2015;132(18suppl2):S501-518.

Link MS, Berkow LC, Kudenchuk PJ et al. Part 7: adult advanced cardiovascular life support: 2015 American
Heart Association guidelines update for cardiopulmonary resuscitatoin and emergency cardiovascular care.
Circulation. 2015;132(18suppl2):S444-464.

Neumar RW, Otto CW, Link MS et al. Part 8: adult advanced cardiovascular life support: 2010 American
Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care.
2010;122(18suppl3):S729-767.

Soar J, Perkins GD, Abbas G et al. European Reuscitation Council guidelines for resuscitation 2010 section
8. Cardiac arrest in special circumstances: electrolyte abnormalities, poisoning, drow ning, accidental
hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution.
2010;81(10):1400-1433.

Surgical Services departmental policy #2.05, Cardiac Arrest Protocol

Appendix A, Cardiac Surgery/Heart Transplant Post Resuscitation Algorithm

X. REVIEW DETAILS
Version: Revision
Next Revision Due: May 2019
Formerly Know n as: Hospital Administrative policy #8.32