Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

How Bad is the Evidence for the New 2015 ACLS Guidelines?

    The new ACLS guidelines are out. How bad is the evidence?

    The short answer – The Advanced Cardiac Life Support guidelines could be worse.

How does the American Heart Association determine that a recommendation is not beneficial?

Class III: No Benefit, is a moderate recommendation, generally reserved for therapies or tests that have been shown in high-level studies (generally LOE A or B) to provide no benefit when tested against a placebo or control.[1]


The tobacco enema has been used successfully as a treatment for cardiac arrest, so the evidence of lack of benefit is poor.[2] Clearly, the Advanced Cardiac Life Support guidelines cannot claim that the tobacco enema is Class III. Successfully? The treatment was used and a dead person was no longer dead. In other words, just as successfully as most of the ACLS treatments.

From Eisenberg, MS. Life in the balance: emergency medicine and the quest to reverse sudden death. 1997; Oxford University Press. [betterworldbooks][3]


This is one way to make excuses for justify doing something just because of ideology. In the absence of good evidence of benefit, we should not harm our patients to protect our ideology. We used to do this with blood-letting, which was defended even after there was clear evidence of harm. That is just the best known example, but this dishonesty continues and continues to be defended.

Why don’t we hold anyone accountable, when we have the evidence that our treatments are harmful? Because we all seem to go along to get along.

The 2015 ACLS guidelines are not all bad, but they clearly do not encourage withholding harmful treatments until we have obvious evidence of harm. Should we assume that a treatment works just because the explanation appeals to some experts as much as the explanation for blood-letting appealed to the experts when that was in vogue?

This is not medicine. This is a fashion show. Our patients are the ones harmed.


[1] 2015 AHA Classes of Recommendation
2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
Part 2: Evidence Evaluation and Management of Conflicts of Interest
Development of the 2015 Guidelines Update
2015; 132: S368-S382
Free Full Text from Circulation.

[2] Tobacco smoke enemas
Ghislaine Lawrence
Volume 359, No. 9315, p1442,
20 April 2002
Abstract with link to Full Text PDF download.

[3] Ever tried smoking?
by Chris Nickson
Life in the Fast Lane

Morrison LJ, Gent LM, Lang E, Nunnally ME, Parker MJ, Callaway CW, Nadkarni VM, Fernandez AR, Billi JE, Egan JR, Griffin RE, Shuster M, & Hazinski MF (2015). Part 2: Evidence Evaluation and Management of Conflicts of Interest: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 132 (18 Suppl 2) PMID: 26472990

Lawrence, G. (2002). Tobacco smoke enemas The Lancet, 359 (9315) DOI: 10.1016/S0140-6736(02)08339-3



  1. Glad to see you chiming in on the new guidelines Rogue Medic – hope you will be dissecting them in more detail in the coming weeks/months!

  2. Don’t Forget to Breathe

    Live human study ‘Development and implementation of an opioid overdose prevention and response program in Toronto, Ontario.’ http://journal.cpha.ca/index.php/cjph/article/view/3788
    Chest compressions only specific to opioid overdose

    2015 AHA Part 10 ‘Special Circumstances of Resuscitation’
    See Part 10.3: p.504 ‘Cardiac or Respiratory Arrest Associated With Opioid Overdose’
    Read hyperlink ALS 441 https://volunteer.heart.org/apps/pico/Pages/PublicComment.aspx?q=441
    Read hyperlink BLS 891 https://volunteer.heart.org/apps/pico/Pages/PublicComment.aspx?q=891

    Bingham K, Klaiman M, Leece P, Orkin A, Buick J. An agenda for naloxone distribution research and practice: Meeting report of the Surviving Opioid Overdose with Naloxone (SOON) International Working Group. J Addict Res Ther. 2015;6:212.

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