How the ACLS exam works, and how to pass it

3 parts

What the ACLS exam is made of

Every path through the AHA Advanced Cardiovascular Life Support (ACLS) Provider Course ends in the same three checks, whether you sit in a classroom for the whole course or do the online part at home first. They test different things, so they need different practice.

Each part has its own practice here: the precourse practice for the self-assessment, the CPR and airway cards for the first two skills tests, Megacode practice cases for the team-leader test, and the 60-card practice test for the written exam.

Written

The written ACLS test

Yes, there is a written ACLS test. Expect usually about 50 multiple-choice questions (as AHA Training Centers report it; confirm the count with yours). It is open resource at most Training Centers, so the provider manual and your notes are usually allowed, which sounds generous until you notice that almost every question is a short case: a rhythm, a blood pressure, a symptom, and four plausible next steps.

What the questions lean on

The AHA does not publish topic weights for the ACLS exam, so any split you see online is an estimate, ours included. The heavy areas are easy to name, though: the cardiac arrest algorithm with its shock-or-no-shock branch, bradycardia and tachycardia with a pulse, the reversible causes (the H’s and T’s), high-quality CPR, post-arrest care, and the first minutes of acute coronary syndromes and stroke.

Skills

The ACLS skills tests and the Megacode

People search for the “ACLS practical exam” more than the written one, and with reason: it is the part you cannot cram. The skills side is a high-quality BLS (adult CPR and AED) skills test, an airway management skills test and the Megacode. The first two are short. The Megacode is where nerves show, because you speak the algorithm instead of choosing it.

1. 01High-quality CPR and the AED

   The manikin reports what you do. Push at 100 to 120 compressions a minute, at least 2 inches deep and no more than 2.4, let the chest recoil fully, and keep the pauses short. When the AED arrives, power it on first, follow its prompts, clear everyone, and restart compressions straight after the shock.

2. 02Airway management

   Expect to open the airway, size and place an adjunct and ventilate with a bag-mask device. The common miss is too much: breaths that are too big or too frequent. Give each breath over about a second, just enough to see the chest rise.

3. 03The Megacode

   The instructor reads a case, you assign roles, and the rhythm on the monitor changes as you treat it. You pass by choosing the right branch each time and saying it as clear, closed-loop orders. Walk through five practice cases before the course day.

2025

What changed with the 2025 Guidelines

The current course follows the 2025 AHA Guidelines for CPR and Emergency Cardiovascular Care, released on October 22, 2025. Instructors had to switch to the new course materials by March 1, 2026, and the ACLS Provider Course was updated to the 2025 Guidelines when they were released. So the questions people ask about “new ACLS guidelines for 2026” are really about the 2025 set.

Most of the arrest algorithm stayed where it was. What catches people is study material from an earlier cycle that still ranks in search. If your notes say any of the left column, they are out of date:

Checked against the 2025 AHA Guidelines for CPR and Emergency Cardiovascular Care, October 2026. Exam preparation for trained providers, not treatment instructions.

The ACLS algorithms page draws the 2025 versions as flowcharts.

Plan

How to pass the ACLS exam: a five-step plan

Most people start a week or two out, a little rusty on the drugs and unsure about the strips. That is enough time if each evening has one job.

1. 01Clear the precourse line early

   Take the self-assessment as soon as your course gives you access. A first score under 70% is common and simply tells you which section to reread; practice the three sections here first if you want a dry run.

2. 02Learn the arrest algorithm as one loop

   Two minutes of CPR, rhythm check, shock or no shock, drug, back to CPR. Say it out loud until the loop is automatic, then add where epinephrine and the antiarrhythmic fit in.

3. 03Split the pulse algorithms by one question

   For bradycardia and tachycardia with a pulse, the first question is always “stable or unstable?”. Drill that decision on the algorithm flowcharts before memorizing any dose.

4. 04Run a full practice deck, then fix one topic

   Take the 60-card practice test, read the score card, and reread only the lowest topic. The Study guide has a day-by-day version of this plan.

5. 05Rehearse one Megacode out loud

   Pick a case from the Megacode practice page and talk through every order as team leader. Doing it once aloud beats reading it five times.

Hard?

Is the ACLS exam hard?

For most candidates it is moderately hard, and the difficulty sits in specific places. Concepts rarely trip people; recall under pressure does. The three usual weak spots are drug doses and their order, telling rhythms apart on a strip, and leading the Megacode without freezing.

Each one has a narrow fix. Doses stick when you meet them inside cases, a few each day. Strips settle by naming ten of them side by side on the precourse rhythm practice. The Megacode settles with one rehearsal out loud.

Renewal

ACLS certification and renewal

ACLS certification means an AHA ACLS Provider course completion card (eCard). It is a course completion card that employers and hospitals ask for, not a government license, and only an AHA Training Center or AHA instructor can issue the card. The card is valid for 2 years; cards are generally treated as valid through the end of the month printed on them. The AHA grants no grace period after that date, so book the renewal before it runs out.

ACLS renewal and recertification

Recertification is a shorter update course or HeartCode ACLS, with the exam and skills tests taken again. Nothing carries over from your last card, which is why the renewal course feels short but not easy. Start the plan above a week ahead and give the table of 2025 changes extra time: renewing providers are the ones most likely to carry an older dose in their head.

HeartCode ACLS and online courses

You can take the course as an instructor-led classroom course or HeartCode ACLS, a blended online-plus-skills path. HeartCode ACLS has an online part with simulated patient cases, then a hands-on skills session with an AHA instructor or a voice-assisted manikin. Either way, every AHA ACLS path ends in a hands-on skills test, so there is no fully online AHA ACLS card. A site that promises an AHA card with no hands-on part is describing something else.

Course formats and Training Centers are listed on the AHA ACLS course options page (opens the AHA site). For anything about your own card or eCard, your Training Center is the place to ask.

FAQ

Questions people ask