When should I consider referring a patient to advanced life support (ALS) services following a cardiac arrest?

Consider referring a patient to advanced life support (ALS) services immediately following a cardiac arrest if:

• The patient has a suspected or confirmed acute coronary syndrome (ACS) with ongoing or recurrent chest pain, as this may indicate a life-threatening cardiac event requiring urgent hospital care and advanced resuscitation measures ¹.
• There is evidence of cardiac arrest or life-threatening arrhythmias detected on ECG or clinical assessment, necessitating advanced airway management, defibrillation, and advanced circulatory support ¹,³.
• The patient is unresponsive or has no effective circulation after initial basic life support measures, indicating the need for escalation to ALS interventions ¹,³.
• Any red flags such as conduction abnormalities, ventricular arrhythmias, or other ECG changes suggestive of severe cardiac instability are present, warranting urgent specialist assessment and ALS referral ³.

In all cases, do not delay transfer to hospital or ALS services while performing diagnostic tests such as ECGs; immediate referral and initiation of ALS is critical to improve outcomes after cardiac arrest ¹,³.