142:
post-traumatic stress, which can all lead to future repeated events. Before being discharged from the hospital, the
American Heart Association recommends that cardiac arrest survivors receive rehabilitation assessment and treatment for physical, neurologic, cardiopulmonary, and cognitive impairments. They also recommend that cardiac arrest survivors and their caregivers receive comprehensive, multidisciplinary discharge planning to include medical and rehabilitative treatment recommendations and return to activity and work expectations.
86:, the American Heart Association re-emphasized the importance of more bystanders performing hands-only CPR until EMS personnel arrive because, at present, fewer than 40% of people who have an out-of-hospital cardiac arrest receive CPR from a bystander. The guidelines recommend lay rescuers start CPR on a person with presumed cardiac arrest because the overall risk of harm to patients from CPR is low, even if their heart hasn't stopped beating. Properly performed CPR can keep the heart in a shockable rhythm for 10–12 minutes longer.
102:, which means their heart has fallen out of rhythm. Early defibrillation is the link in the chain most likely to improve survival since defibrillation can help shock the heart back into a regular beat. Early, rapid defibrillation is considered the most important link in the chain of survival. Rapid defibrillation outside of the hospital improves the chances of survival by as much as 30%, and involves using an automated external defibrillator (AED) to shock the patient's heart.
45:
emergency medical care was the first link, the second link was early CPR, early defibrillation was the third link, and the final link was early advanced cardiac life support. Over the years, the
American Heart Association has added two new links to the chain: post-resuscitation care in 2010, and physical and emotional recovery in 2020. Also in 2020, the American Heart Association issued a new pediatric chain of survival for infants, children, and adolescents.
32:, and physical and emotional recovery. The first three links in the chain can be performed by lay bystanders, while the second three links are designated to medical professionals. Currently, between 70 and 90% of cardiac arrest patients die before they reach the hospital. However, a cardiac arrest does not have to be lethal if bystanders can take the right steps immediately.
109:
AEDs are becoming more common in businesses, schools, and even the home as the public becomes more aware of the importance of rapid defibrillation. AEDs come with pre-recorded instructions and are easy to use. If an AED is not available, bystanders will need to continue CPR until emergency responders
105:
While CPR keeps blood flowing artificially, rapid defibrillation is the only way to restart the heart and reset it to a healthy rhythm. And while only 40% of adults experiencing cardiac arrest receive CPR, fewer than 12% receive shocks from an AED before EMS arrival. What is more, the chances of the
73:
as early as possible with an immediate call to the emergency services. Unfortunately, many persons experiencing symptoms (for example, angina) that may lead to a cardiac arrest ignore these warning symptoms or, recognizing these warning symptoms correctly, fail to activate the EMS system, preferring
48:
Mary M. Newman, co-founder and president/CEO of the Sudden
Cardiac Arrest (SCA) Foundation and previous executive director of the National Center for Early Defibrillation at the University of Pittsburgh, developed the chain of survival metaphor and first described it in an article she wrote for the
132:
Often, ACLS ambulance providers will attach an electrocardiogram to the patient and transmit its findings to the receiving hospital or care facility, which leads to earlier diagnosis of a heart attack, and significantly reduces time to treatment at the hospital. This prearrival ECG and notification
44:
To improve survival outcomes for people who have experienced out-of-hospital cardiac arrest, the
American Heart Association–International Liaison Committee on Resuscitation recommended the chain of survival concept in the early 2000s. Originally, the chain consisted of four steps: early access to
40:
According to the
American Heart Association, out-of-hospital cardiac arrest can affect more than 300,000 people in the United States each year. Three minutes after the onset of cardiac arrest, a lack of blood flow starts to damage the brain, and 10 minutes after, the chances of survival are low.
128:
Some ACLS ambulance providers will administer medications to manage pain, arrhythmias, shock, and pulmonary congestion; monitor the heart rhythm to identify any potentially lethal cardiac arrhythmias; or initiate transcutaneous pacing. ACLS ambulance providers use the mnemonic "MONA" (morphine,
141:
In
October 2020, the American Heart Association added the recovery phase as the sixth link in the chain of survival. Recovery consists of cardiac arrest survivors receiving treatment, surveillance, and rehabilitation at a hospital. It also includes an assessment for anxiety, depression, and
145:
A patient's recovery from cardiac arrest continues long after their initial hospitalization following the event, so the
American Heart Association recommended in their 2020 guidelines that patients have formal assessment and support for their physical, cognitive, and psychosocial needs.
133:
has been shown to improve patient outcomes. In the event of a complication at the scene of the event or on the way to the hospital, ACLS ambulance providers can administer life saving therapies, including CPR, rapid defibrillation, airway management, and intravenous medications.
562:"Improving survival from sudden cardiac arrest: the "chain of survival" concept. A statement for health professionals from the Advanced Cardiac Life Support Subcommittee and the Emergency Cardiac Care Committee, American Heart Association"
415:
Peberdy, Mary Ann; Callaway, Clifton W.; Neumar, Robert W.; Geocadin, Romergryko G.; Zimmerman, Janice L.; Donnino, Michael; Gabrielli, Andrea; Silvers, Scott M.; Zaritsky, Arno L.; Merchant, Raina; Vanden Hoek, Terry L. (2010-11-02).
24:. Like any chain, the chain of survival is only as strong as its weakest link. The six interdependent links in the chain of survival are early recognition of sudden cardiac arrest and access to emergency medical care, early
711:
Weisfeldt, Myron L.; Everson-Stewart, Siobhan; Sitlani, Colleen; Rea, Thomas; Aufderheide, Tom P.; Atkins, Dianne L.; Bigham, Blair; Brooks, Steven C.; Foerster, Christopher; Gray, Randal; Ornato, Joseph P. (2011-01-27).
274:
Tagami, Takashi; Hirata, Kazuhiko; Takeshige, Toshiyuki; Matsui, Junichiroh; Takinami, Makoto; Satake, Masataka; Satake, Shuichi; Yui, Tokuo; Itabashi, Kunihiro; Sakata, Toshio; Tosa, Ryoichi (2012-07-31).
113:
Public access defibrillation may be the key to improving survival rates in out-of-hospital cardiac arrest, but is of the greatest value when the other links in the chain do not fail.
125:
by paramedics is another critical link in the chain of survival. In communities with survival rates > 20%, a minimum of two of the rescuers are trained to the advanced level.
601:"Guidelines for cardiopulmonary resuscitation and emergency cardiac care. Emergency Cardiac Care Committee and Subcommittees, American Heart Association. Part I. Introduction".
61:
and emergency cardiac care, The
International Liaison Committee on Resuscitation (ILCOR) echoed the concept in 1997. The links of the Chain of survival are described below.
636:
868:
844:
335:
83:
165:
769:
796:
74:
to contact relatives instead (e.g., the elderly often contact their adult offspring rather than contact emergency services).
820:
69:
Ideally, someone must recognize an impending cardiac arrest or otherwise witness the cardiac arrest and activate the
938:
905:
57:
in 1990. The
American Heart Association later adopted the concept and elaborated on it in its 1992 guidelines for
110:
arrive with a defibrillator, which is why it is important to recognize cardiac arrest and call for help quickly.
129:
oxygen, nitroglycerin, and aspirin) to reflect the out-of-hospital therapies they will use for cardiac arrest.
106:
patient's survival decrease by as much as 10% with every minute that they do not receive rapid defibrillation.
913:
41:
Therefore, bystanders have only a few minutes to act to optimize a person's chances of survival and recovery.
171:
122:
58:
29:
25:
933:
797:"AEDs- High-Tech Help for Cardiac Arrest - Health Encyclopedia - University of Rochester Medical Center"
474:
899:
70:
277:"Implementation of the Fifth Link of the Chain of Survival Concept for Out-of-Hospital Cardiac Arrest"
82:
To be most effective, bystanders should provide CPR immediately after a patient collapses. In their
95:
895:
99:
673:
211:"Part 12: From Science to Survival - Strengthening the Chain of Survival in Every Community,"
20:
refers to a series of actions that, properly executed, reduce the mortality associated with
8:
928:
359:
746:
713:
693:
447:
155:
434:
417:
293:
276:
210:
751:
733:
697:
618:
583:
439:
298:
249:
741:
725:
685:
610:
573:
429:
288:
239:
689:
498:
451:
181:
176:
160:
53:
in 1989, and further promoted in an editorial she wrote for the first issue of
21:
922:
737:
614:
578:
561:
390:
714:"Ventricular Tachyarrhythmias after Cardiac Arrest in Public versus at Home"
755:
443:
302:
244:
227:
729:
622:
587:
253:
668:
666:
664:
662:
660:
658:
656:
186:
845:"Public access to AEDs is growing, so why aren't they being used?"
710:
391:"Chain of Survival - What is it? Cardiac, Stroke & Pediatric"
653:
541:
Newman MM (1990). "The Chain of
Survival: Converting a Nation".
336:"Updated CPR guidelines address physical and emotional recovery"
770:"Cardiopulmonary resuscitation (CPR) | betterhealth.vic.gov.au"
522:
Newman M (1989). "The chain of survival concept takes hold".
414:
273:
469:
467:
465:
463:
461:
64:
869:"Automated external defibrillators: Do you need an AED?"
94:
Most adults who can be saved from cardiac arrest are in
458:
559:
791:
789:
821:"Every Second Counts - AED fact sheet 2013 - Final"
786:
560:Cummins RO, Ornato JP, Thies WH, Pepe PE (1991).
920:
269:
267:
265:
263:
228:"Fibrillation and defibrillation of the heart"
206:
204:
202:
260:
385:
383:
381:
379:
330:
328:
326:
324:
322:
320:
318:
316:
314:
312:
225:
219:
199:
166:Cardiac Arrest Registry to Enhance Survival
906:"Chain of Survival: Converting a Nation,"
745:
577:
540:
433:
376:
292:
243:
521:
309:
89:
921:
116:
65:Early access to emergency medical care
896:"The Links in the Chain of Survival,"
51:Journal of Emergency Medical Services
13:
674:"Part 3: Adult Basic Life Support"
543:Currents in Emergency Cardiac Care
418:"Part 9: Post–Cardiac Arrest Care"
55:Currents in Emergency Cardiac Care
14:
950:
889:
435:10.1161/CIRCULATIONAHA.110.971002
294:10.1161/CIRCULATIONAHA.111.086173
914:Sudden Cardiac Arrest Foundation
503:Sudden Cardiac Arrest Foundation
861:
837:
813:
762:
718:New England Journal of Medicine
704:
629:
594:
553:
534:
515:
849:www.cardiovascularbusiness.com
491:
408:
352:
232:British Journal of Anaesthesia
28:, early defibrillation, early
1:
690:10.1161/circ.102.suppl_1.I-22
684:(suppl_1): I–22. 2000-08-22.
192:
172:Cardiopulmonary resuscitation
123:advanced cardiac life support
59:cardiopulmonary resuscitation
35:
30:advanced cardiac life support
77:
7:
774:www.betterhealth.vic.gov.au
149:
136:
10:
955:
900:American Heart Association
475:"CPR & ECC Guidelines"
637:"Arrhythmia | NHLBI, NIH"
428:(18_suppl_3): S768–S786.
615:10.1001/jama.268.16.2171
579:10.1161/01.cir.83.5.1832
96:ventricular fibrillation
939:Public health education
100:ventricular tachycardia
909:Citizen CPR Foundation
801:www.urmc.rochester.edu
730:10.1056/NEJMoa1010663
609:(16): 2171–83. 1992.
360:"CPR Facts and Stats"
22:sudden cardiac arrest
499:"Mary M. Newman, MS"
245:10.1093/bja/79.2.203
226:Bossaert LL (1997).
90:Early defibrillation
934:Medical terminology
117:Early advanced care
156:Basic life support
641:www.nhlbi.nih.gov
18:chain of survival
946:
883:
882:
880:
879:
865:
859:
858:
856:
855:
841:
835:
834:
832:
831:
817:
811:
810:
808:
807:
793:
784:
783:
781:
780:
766:
760:
759:
749:
708:
702:
701:
670:
651:
650:
648:
647:
633:
627:
626:
598:
592:
591:
581:
557:
551:
550:
538:
532:
531:
519:
513:
512:
510:
509:
495:
489:
488:
486:
485:
471:
456:
455:
437:
412:
406:
405:
403:
402:
387:
374:
373:
371:
370:
356:
350:
349:
347:
346:
332:
307:
306:
296:
271:
258:
257:
247:
223:
217:
208:
954:
953:
949:
948:
947:
945:
944:
943:
919:
918:
892:
887:
886:
877:
875:
867:
866:
862:
853:
851:
843:
842:
838:
829:
827:
819:
818:
814:
805:
803:
795:
794:
787:
778:
776:
768:
767:
763:
709:
705:
672:
671:
654:
645:
643:
635:
634:
630:
600:
599:
595:
558:
554:
539:
535:
520:
516:
507:
505:
497:
496:
492:
483:
481:
473:
472:
459:
413:
409:
400:
398:
389:
388:
377:
368:
366:
358:
357:
353:
344:
342:
334:
333:
310:
272:
261:
224:
220:
209:
200:
195:
182:Call-Push-Shock
152:
139:
119:
92:
84:2015 guidelines
80:
67:
38:
12:
11:
5:
952:
942:
941:
936:
931:
917:
916:
911:
903:
891:
890:External links
888:
885:
884:
860:
836:
812:
785:
761:
724:(4): 313–321.
703:
652:
628:
593:
572:(5): 1832–47.
552:
533:
514:
490:
457:
407:
375:
351:
308:
287:(5): 589–597.
259:
218:
216:2000;102:I-358
197:
196:
194:
191:
190:
189:
184:
179:
177:Defibrillation
174:
169:
163:
161:Cardiac arrest
158:
151:
148:
138:
135:
118:
115:
91:
88:
79:
76:
66:
63:
37:
34:
9:
6:
4:
3:
2:
951:
940:
937:
935:
932:
930:
927:
926:
924:
915:
912:
910:
907:
904:
902:
901:
897:
894:
893:
874:
870:
864:
850:
846:
840:
826:
822:
816:
802:
798:
792:
790:
775:
771:
765:
757:
753:
748:
743:
739:
735:
731:
727:
723:
719:
715:
707:
699:
695:
691:
687:
683:
679:
675:
669:
667:
665:
663:
661:
659:
657:
642:
638:
632:
624:
620:
616:
612:
608:
604:
597:
589:
585:
580:
575:
571:
567:
563:
556:
548:
544:
537:
529:
525:
518:
504:
500:
494:
480:
479:cpr.heart.org
476:
470:
468:
466:
464:
462:
453:
449:
445:
441:
436:
431:
427:
423:
419:
411:
396:
392:
386:
384:
382:
380:
365:
364:cpr.heart.org
361:
355:
341:
340:www.heart.org
337:
331:
329:
327:
325:
323:
321:
319:
317:
315:
313:
304:
300:
295:
290:
286:
282:
278:
270:
268:
266:
264:
255:
251:
246:
241:
238:(2): 203–13.
237:
233:
229:
222:
215:
212:
207:
205:
203:
198:
188:
185:
183:
180:
178:
175:
173:
170:
167:
164:
162:
159:
157:
154:
153:
147:
143:
134:
130:
126:
124:
114:
111:
107:
103:
101:
98:or pulseless
97:
87:
85:
75:
72:
62:
60:
56:
52:
46:
42:
33:
31:
27:
23:
19:
908:
898:
876:. Retrieved
872:
863:
852:. Retrieved
848:
839:
828:. Retrieved
825:studylib.net
824:
815:
804:. Retrieved
800:
777:. Retrieved
773:
764:
721:
717:
706:
681:
677:
644:. Retrieved
640:
631:
606:
602:
596:
569:
565:
555:
546:
542:
536:
527:
523:
517:
506:. Retrieved
502:
493:
482:. Retrieved
478:
425:
421:
410:
399:. Retrieved
397:. 2021-04-27
394:
367:. Retrieved
363:
354:
343:. Retrieved
339:
284:
280:
235:
231:
221:
213:
144:
140:
131:
127:
120:
112:
108:
104:
93:
81:
68:
54:
50:
47:
43:
39:
17:
15:
873:Mayo Clinic
678:Circulation
566:Circulation
422:Circulation
281:Circulation
214:Circulation
929:Cardiology
923:Categories
878:2021-05-19
854:2021-05-19
830:2021-05-19
806:2021-05-19
779:2021-05-19
646:2021-05-19
508:2021-05-19
484:2021-05-19
401:2021-05-19
395:avive.life
369:2021-05-19
345:2021-05-19
193:References
71:EMS system
36:Background
738:0028-4793
698:247578012
78:Early CPR
756:21268723
530:: 11–13.
444:20956225
303:22850361
187:Rearrest
150:See also
137:Recovery
747:3062845
623:1404767
588:2022039
549:(1): 3.
254:9349131
168:(CARES)
754:
744:
736:
696:
621:
586:
452:573398
450:
442:
301:
252:
121:Early
694:S2CID
448:S2CID
752:PMID
734:ISSN
619:PMID
603:JAMA
584:PMID
524:JEMS
440:PMID
299:PMID
250:PMID
16:The
742:PMC
726:doi
722:364
686:doi
682:102
611:doi
607:268
574:doi
430:doi
426:122
289:doi
285:126
240:doi
26:CPR
925::
871:.
847:.
823:.
799:.
788:^
772:.
750:.
740:.
732:.
720:.
716:.
692:.
680:.
676:.
655:^
639:.
617:.
605:.
582:.
570:83
568:.
564:.
545:.
528:14
526:.
501:.
477:.
460:^
446:.
438:.
424:.
420:.
393:.
378:^
362:.
338:.
311:^
297:.
283:.
279:.
262:^
248:.
236:79
234:.
230:.
201:^
881:.
857:.
833:.
809:.
782:.
758:.
728::
700:.
688::
649:.
625:.
613::
590:.
576::
547:1
511:.
487:.
454:.
432::
404:.
372:.
348:.
305:.
291::
256:.
242::
Text is available under the Creative Commons Attribution-ShareAlike License. Additional terms may apply.