ANZAAG vs ALS: Navigating Competing Resuscitation Frameworks
Apr 27, 2026
Perianaesthesia nurses often find themselves at a clinical crossroads when anaphylaxis unfolds in the perioperative space. The environment is controlled, monitored, and immediate, yet the response pathways can feel conflicting. Do we follow ANZAAG or default to ALS?
To answer this you must ask: what is the systolic blood pressure?
- Over 50mmHg 👉 ANZAAG algorithm
- Below 50mmHg 👉 ALS guideline (likely for non-shockable rhythm)
Understanding why both frameworks exist is the first step to using them well.
ANZAAG guidelines are designed specifically for perioperative anaphylaxis, where the patient is anaesthetised, monitored, and often deteriorating rapidly under direct clinical care. They prioritise early intravenous adrenaline, airway control, and rapid volume replacement, supported by structured crisis cards for real-time use. It assumes the patient has a survivable cardiac output.
ALS, on the other hand, is built for cardiac arrest of any cause. It follows a standardised algorithm, focusing on chest compressions, defibrillation, and identifying reversible causes. In anaphylaxis-related arrest, ALS still applies, but only once arrest has occurred .
The tension sits in the transition point.
- ⚡ ANZAAG prioritises early IV adrenaline in a monitored patient before collapse
- ⚡ ANZAAG assumes airway control and anaesthetic context
- ⚡ ALS assumes undifferentiated collapse and broader causes
- ⚡ Both frameworks emphasise adrenaline as first-line treatment
In practice, these are not competing systems. They are sequential.
Early recognition and aggressive management using ANZAAG principles can prevent progression to cardiac arrest. If arrest occurs, ALS takes over, while still treating anaphylaxis as the reversible cause.
For perianaesthesia nurses, the key is situational awareness. Recognise where your patient sits on that trajectory, and don't be afraid to alert the team if it's time to start chest compressions!
When we align the framework to the context, clarity follows. Early, decisive action is what changes outcomes.
Build Knowledge ✅
Improve Safety ✅
References:
Kolawole, H., Marshall, S.D., Crilly, H., Kerridge, R., Roessler, P. (2017). ANZAAG/ANZCA Perioperative Anaphylaxis Management Guidelines. Anaesthesia and Intensive Care.
McLure, M., Eastwood, K.J., Parr, M., Bray, J. (2021). A rapid review of advanced life support guidelines for cardiac arrest associated with anaphylaxis. Resuscitation.
Stay connected with news and updates!
Join our mailing list to receive the latest news and updates from our team.
Don't worry, your information will not be shared.
We hate SPAM. We will never sell your information, for any reason.