ACLS certification is a credential for healthcare professionals that proves competency in managing cardiac arrest, stroke, and other life-threatening cardiovascular emergencies. Developed by the American Heart Association (AHA), the course teaches a standardized set of interventions that go well beyond basic CPR, including reading heart rhythms, using a defibrillator, placing advanced airways, and administering emergency medications through an IV. If you’ve seen a job listing that requires it or you’re entering a clinical field, here’s what the certification involves and how to get it.
What ACLS Covers
ACLS stands for Advanced Cardiovascular Life Support. The core of the course is a series of step-by-step decision algorithms that tell a healthcare team exactly what to do, in what order, when a patient’s heart stops or starts beating dangerously fast or slow. The major algorithms include adult cardiac arrest, fast heart rhythms with a pulse (tachycardia), slow heart rhythms with a pulse (bradycardia), electrical cardioversion, and post-cardiac arrest care.
Each algorithm combines several skills. You learn high-quality CPR technique, how to interpret common heart rhythms on a monitor, when and how to deliver an electrical shock, and which emergency drugs to give at specific intervals. For example, the cardiac arrest algorithm calls for epinephrine every 3 to 5 minutes and specifies exact doses of amiodarone for certain types of arrest. The goal is to remove guesswork during a crisis so that every member of the team follows the same evidence-based playbook.
Who Needs ACLS Certification
ACLS is designed for anyone who directs or participates in managing cardiovascular emergencies. The AHA specifically lists personnel in emergency response, emergency medicine, critical care and intensive care, and surgery. In practice, this means physicians, nurses, paramedics, respiratory therapists, and others who work in settings where a patient could go into cardiac arrest. Many hospitals, clinics, and EMS agencies require a current ACLS card as a condition of employment.
If you’re a nursing student, medical resident, or new hire rotating into an emergency department or ICU, expect your employer or program to verify your ACLS status before you start. Some employers are strict about which organization issued the card (more on that below), so it’s worth checking your workplace’s policy before you register for a course.
Prerequisites Before You Enroll
ACLS is not an introductory course. You’re expected to already hold a current Basic Life Support (BLS) certification and have a working knowledge of two foundational areas: ECG rhythm recognition and emergency pharmacology. The AHA acknowledges that without strong competency in both, passing the ACLS course is significantly harder.
If you’re rusty or new to reading heart rhythms, the AHA offers separate prep modules for ECG recognition and pharmacology that you can complete before the full course. These aren’t mandatory, but they exist because many students struggle with the material without that baseline. If you haven’t routinely looked at cardiac monitors or studied emergency drug protocols, investing time in prep work will make the actual course far more manageable.
Course Format and Time Commitment
There are two main ways to complete ACLS certification. The traditional classroom course is instructor-led over one to two days, typically running about 14 to 16 hours total. It combines lectures, group discussions, and hands-on practice stations where you work through simulated emergencies with mannequins and monitoring equipment.
The blended learning option, called HeartCode ACLS, lets you complete the didactic portion online at your own pace. You then schedule a separate in-person skills session with an AHA instructor or a compatible simulation mannequin. This format gives you more flexibility, especially if your schedule doesn’t allow for two consecutive classroom days. The online portion alone costs $173 through the AHA, and the hands-on skills session is purchased separately through a local AHA Training Center. All-in, expect to spend roughly $175 to $300 depending on your location and format.
The Skills Test
Regardless of which format you choose, ACLS certification requires passing both a written exam and a hands-on skills evaluation. The written test covers rhythm identification, algorithm sequences, and pharmacology. The hands-on portion is commonly called the “Megacode,” a simulated cardiac arrest scenario where you lead or participate in a full resuscitation from start to finish. You’re assessed on whether you follow the correct algorithm, deliver high-quality CPR, make appropriate defibrillation decisions, and communicate clearly with your team.
The Megacode is the part most people find stressful, because it requires you to think on your feet while integrating everything you’ve learned. Practicing the algorithms until they feel automatic is the most effective way to prepare. If you don’t pass on the first attempt, most training centers allow at least one remediation and retest opportunity.
How Long Certification Lasts
An ACLS course completion card is valid for two years. After that, you’ll need to take a renewal (or “update”) course to maintain your certification. Renewal courses are shorter than the initial course because they assume you already have the foundational knowledge and focus on updated science, refreshed skills practice, and a new Megacode evaluation.
The AHA periodically updates its resuscitation guidelines based on new evidence. The most recent major update, the 2025 AHA Guidelines for CPR and Emergency Cardiovascular Care, was published in October 2025. All AHA instructors are required to complete a guidelines update by February 2026, and the new science will be incorporated into courses going forward. If you’re renewing soon, your course content may reflect these latest changes.
AHA vs. Red Cross Certification
For decades, the AHA was the only major organization offering ACLS training. That changed in 2019 when the American Red Cross launched its own suite of advanced life support courses. Both organizations base their curricula on the same international science body, the International Liaison Committee on Resuscitation (ILCOR), which issues consensus treatment recommendations to member organizations worldwide. Because of this shared scientific foundation, the two programs teach the same core concepts and practice standards.
The U.S. Defense Health Agency conducted a formal comparison of the two curricula and confirmed their equivalence, subsequently accepting Red Cross BLS, ACLS, and PALS training for all military and civilian personnel. National accrediting bodies, state agencies, and thousands of hospitals accept both cards.
That said, some medical centers, nursing schools, and community colleges still have policies that only recognize AHA certification. This can create a frustrating situation where a new hire or rotating trainee with a valid Red Cross card has to recertify through the AHA before starting work. Before you register for any course, confirm which credential your employer or school accepts. If you’re unsure or expect to change jobs in the next two years, AHA certification remains the safer bet simply because of its longer track record and broader default acceptance.
What Makes Red Cross Courses Different
While the science is equivalent, the learning experience differs. Red Cross courses are designed to reduce total training time and use a more interactive, learner-centered approach. Their training videos feature actual physicians, nurses, and support staff demonstrating clinical decision-making and teamwork, rather than actors. For experienced clinicians who want efficient, practice-focused training, this format can feel more relevant. The AHA’s HeartCode blended option offers its own flexibility through self-paced online learning. Both routes end at the same destination: a valid advanced life support credential.