ACLS — Advanced Cardiovascular Life Support — is a set of clinical interventions and algorithms developed by the American Heart Association (AHA) for the treatment of life-threatening cardiovascular emergencies, including cardiac arrest, stroke, acute coronary syndromes, and serious arrhythmias. ACLS certification is the credential that validates a healthcare provider's knowledge and skills in applying these interventions.
ACLS builds on Basic Life Support (BLS) — the foundational CPR and AED skills required of all healthcare providers — by adding advanced interventions: pharmacological therapy (epinephrine, amiodarone, adenosine, and other cardiac medications), advanced airway management (endotracheal intubation, supraglottic airways), cardiac rhythm interpretation, electrical therapy (defibrillation, synchronized cardioversion, transcutaneous pacing), and systematic algorithmic approaches to cardiac arrest rhythms and other cardiovascular emergencies.
The ACLS certification course is provided primarily by the American Heart Association, though other organizations including the American Red Cross and various online providers also offer ACLS programs. The AHA ACLS course is the gold standard in the United States and is required or preferred by most hospitals and health systems for qualifying clinical positions. ACLS certification is valid for two years, after which providers must complete an ACLS renewal course to maintain their certification.
ACLS certification is required for healthcare providers who may need to respond to or lead responses to cardiovascular emergencies in their clinical practice. The specific positions that require ACLS vary by employer and setting, but there are consistent patterns across healthcare in the United States.
In hospital settings, ACLS certification is typically required for registered nurses working in critical care units (ICU, CCU, CICU), emergency departments, cardiac care units, progressive care units, perioperative settings (operating room and post-anesthesia care), labor and delivery, and most medical-surgical floors. Physicians, physician assistants, and nurse practitioners in acute care settings are also typically required to maintain ACLS certification. Respiratory therapists, particularly those working in ICU and emergency settings, are often required to hold ACLS as well.
Emergency medical technicians (EMTs) at the advanced level (AEMT) and paramedics typically hold ACLS certification or its equivalent — paramedic training incorporates the same pharmacological and advanced airway interventions covered in ACLS. Flight medics and flight nurses working in air medical transport routinely maintain ACLS along with other specialty certifications. Some ground-level emergency responders in departments with expanded scopes of practice also hold ACLS certification.
Outpatient settings with high-acuity populations — cardiac catheterization laboratories, electrophysiology labs, endoscopy suites, radiology departments performing interventional procedures, and oral surgery offices — frequently require or strongly prefer ACLS-certified staff. Nurse anesthetists (CRNAs) and anesthesiologists maintain ACLS as a baseline certification given the nature of their work. Nursing students in clinical rotations at teaching hospitals are sometimes required to obtain ACLS during their programs, and many nursing schools incorporate ACLS preparation into their curricula for students who will work in acute care.
The core of ACLS training is the systematic application of evidence-based algorithms — decision trees that guide clinicians through the appropriate interventions for each type of cardiovascular emergency. Mastering these algorithms is the primary challenge of ACLS certification and the focus of both the written exam and the skills stations.
The cardiac arrest algorithm branches based on the presenting rhythm. Shockable rhythms — ventricular fibrillation (VF) and pulseless ventricular tachycardia (pVT) — are treated with immediate defibrillation, high-quality CPR, epinephrine every 3 to 5 minutes, and amiodarone or lidocaine after the third shock. Non-shockable rhythms — pulseless electrical activity (PEA) and asystole — are treated with high-quality CPR, epinephrine every 3 to 5 minutes, and investigation and treatment of reversible causes (the Hs and Ts).
The Hs and Ts are a systematic framework for identifying reversible causes of cardiac arrest: Hs include Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo/Hyperkalemia, and Hypothermia. Ts include Tension pneumothorax, Tamponade (cardiac), Toxins, and Thrombosis (pulmonary or coronary). The ACLS exam reliably tests knowledge of the Hs and Ts, and rapid identification of reversible causes is a critical component of ACLS performance in real cardiac arrests.
The bradycardia algorithm applies to patients with a heart rate below 60 bpm who are symptomatic — meaning the bradycardia is causing signs of poor perfusion (hypotension, altered mental status, ischemic chest pain, or acute heart failure). First-line treatment is atropine (0.5 mg IV, repeated up to 3 mg total); if atropine is ineffective, transcutaneous pacing or dopamine/epinephrine infusions are second-line interventions while preparing for transvenous pacing.
The tachycardia algorithm branches based on whether the patient is stable or unstable, and whether the QRS is narrow or wide. Unstable patients (with serious signs and symptoms caused by the tachycardia) receive synchronized cardioversion regardless of rhythm. Stable patients with narrow-complex tachycardia (likely SVT) receive vagal maneuvers first, then adenosine. Stable wide-complex tachycardia (likely ventricular tachycardia) receives amiodarone. The ACLS exam tests the correct sequence of interventions and the correct drug dosing for each algorithm branch.
The ACS algorithm covers the initial assessment and treatment of patients with suspected myocardial infarction: 12-lead EKG within 10 minutes of first medical contact, aspirin administration, nitroglycerin for ongoing chest pain, oxygen only if SpO2 is below 90%, and rapid identification of STEMI for catheterization lab activation. The stroke algorithm covers Cincinnati Stroke Scale assessment (facial droop, arm drift, speech abnormality), immediate CT scan, and the critical time window for tPA administration in ischemic stroke (within 3 to 4.5 hours of symptom onset in eligible patients). Both algorithms are tested in ACLS scenarios and written exams.
ACLS certification is obtained through a structured course that combines didactic learning, rhythm recognition practice, and hands-on skills stations. Understanding the course format and requirements helps candidates prepare effectively and avoid common failure points.
The American Heart Association ACLS course is offered in two primary formats: traditional classroom (HeartCode ACLS with skills session) and blended learning (online pre-course work completed before an in-person skills and testing day). The traditional course typically runs 1.5 to 2 days. The blended HeartCode format allows candidates to complete the self-directed online learning portion at their own pace and then attend a skills station session that takes approximately 4 to 8 hours.
The ACLS course includes: a written examination (typically 50 questions, requiring a score of 84% or higher to pass); rhythm identification assessments; and a series of scenario-based skills stations where candidates must demonstrate correct algorithm application as either a team leader or team member. Candidates who fail the written exam or skills stations are given one opportunity to remediate and retest within the same course. If remediation is unsuccessful, the candidate must retake the full course.
Current BLS (Basic Life Support) for Healthcare Providers certification from the AHA is required before taking an ACLS course. BLS certification establishes the foundational skills — high-quality CPR, AED use, and team dynamics — that ACLS builds upon. Candidates who do not hold a current BLS certification cannot enroll in ACLS. Many hospitals that require ACLS also handle scheduling BLS and ACLS courses together for new hires who need both credentials.
Fully online ACLS certifications that do not require any in-person skills verification are offered by some third-party organizations, but they are not accepted by most hospitals and health systems, which typically require AHA certification specifically. Before completing an online-only ACLS program, verify whether your employer accepts that provider's certification. Most employers that list ACLS as a requirement specify AHA ACLS certification or equivalent — and most interpret 'equivalent' to require in-person skills verification.
ACLS certification is valid for two years from the date of certification. Maintaining current ACLS certification is the responsibility of the individual provider — most hospitals track their staff's certification expiration dates and will notify providers when renewals are approaching, but the provider is ultimately responsible for completing renewal before expiration.
ACLS renewal (Heartcode ACLS Renewal or classroom-based ACLS Renewal) is shorter than the initial ACLS certification course. The renewal course assumes prior ACLS knowledge and focuses on updates to guidelines, skill refreshers, and scenario-based assessments. The renewal written exam and skills stations cover the same content as the initial course, but the classroom time is condensed — typically 4 to 8 hours depending on format. Providers who have let their certification lapse and are more than 90 days expired typically must repeat the full initial ACLS course rather than the renewal course.
The AHA updates its resuscitation guidelines every five years (most recently in 2020, with the next major update expected in 2025). When guidelines are updated, ACLS course content is revised to reflect the changes. Providers renewing their ACLS certification will receive updated training that incorporates any guideline changes since their last certification. Key changes from the 2020 guidelines — which affect current ACLS practice — include updated emphasis on minimizing interruptions to chest compressions, updated dosing clarifications for epinephrine timing in cardiac arrest, and updated approaches to post-cardiac arrest care.
Schedule ACLS renewal at least 30 to 60 days before your certification expiration date to ensure availability of seats in courses at your preferred location. Hospital-based education departments often schedule group ACLS renewal sessions — check with your hospital's education or nursing professional development department for scheduled offerings before booking through an outside provider. Some hospitals reimburse ACLS renewal costs for employed providers — verify your employer's policy before paying out of pocket.