Current knowledge of resuscitation and cardiac arrest best practices focus on material and skills obtained in bi-annual ACLS courses. However, ACLS was designed to provide guidelines for out of hospital cardiac arrest (OHCA) and there are unique elements of perioperative arrest that are not articulated in these guidelines. Patient safety relies on specialized knowledge regarding considerations for perioperative arrest so that specific causes can be addressed and management can be tailored to scenarios not covered in ACLS. This presentation will provide evidence-based knowledge and skills to fill this gap so that CRNA's can provide tailored care to unstable patients. A brief discussion about the epidemiology of perioperative arrest will open the presentation. Evidence based strategies for tailoring ACLS to meet the unique needs of the operative setting will then be explored along with specific emergency scenarios and management pearls.