Survival after cardiac arrest depends on a series of critical interventions. If anyone of these critical actions is neglected or delayed, survival is unlikely. Emergency cardiovascular care (ECC) and cardiopulmonary resuscitation (CPR) recommendations first described the flow charts as a major tool to perform Advance Cardiac Life Support (ACLS) for the sudden cardiac death since 1986. Now, the most widely accepted standard for cardiac resuscitation is the ACLS recommendations and protocols published by AHA. The standard is reviewed intensively by the committee of ECC every 6 years. The 1992 guidelines (JAMA) described early access, early cardiopulmonary resuscitation (CPR), early defibrillate on, and early advance care as essential components or links in the chain of survival. Since 1992 the chain of survival has been widely promoted and has become the underlying concept for treatment of cardiac arrest. The last major standards updates were in 2000. These guidelines for ACLS are evidenced-based. The concepts were discussed and approved by members of the International Liaison Committee on Resuscitation ( ILCOR ). Members of committee consisted of more than 40% of non-US. Their Guidelines are no longer simply {{descriptive{{ but now are {{prescriptive.{{ The chain of survival concept underscores several important principles that were frequently evaluated by new evidences and verified additional changes to be proposed as new guidelines. A decade has passed since the chain of survival was introduced, and numerous strategies within each link have been studied to improve outcome in victims of cardiac arrest and effectiveness of the emergency medical systems. Our report is based on final published ACLS changes. We will review new progress in airway, oxygenation, defibrillation, assisting circulation, arrhythmia management and pharmacology recommendations. Changes of algorithm about ILCOR universal/international algorithm, ECC Comprehensive Algorithm, Puls?
