The Chain of Survival for Cardiac Arrest

The Chain of Survival is a term used to describe the care provided to a victim of sudden cardiac arrest. But what exactly are the individual links in the chain of survival? Let’s take a look in more detail at the adult and pediatric chain of survival.

The Adult Chain of Survival

The American Heart Association (AHA) has adopted, supported, and helped develop the concept of emergency cardiovascular care (ECC) systems for many years. The term Chain of Survival provides a useful metaphor for the elements of the ECC systems concept. The five links in the adult Chain of Survival are:

  • Immediate recognition of cardiac arrest and activation of the emergency response system
  • Early cardiopulmonary resuscitation (CPR) with an emphasis on high-quality chest compressions
  • Rapid defibrillation
  • Effective advanced life support (ALS)
  • Integrated post-cardiac arrest care

Although basic life support is taught as a sequence of distinct steps to enhance skills retention and clarify priorities, several actions should be accomplished simultaneously when multiple rescuers are present.

The Pediatric Chain of Survival

Although in adults cardiac is often sudden and results from a cardiac cause, in children cardiac arrest is often secondary to respiratory failure and shock. Identifying children with these problems is essential to reduce the likelihood of pediatric cardiac arrest and maximize survival and recovery. Therefore, a prevention link is added in the pediatric Chain of Survival:

  • Prevention of cardiac arrest
  • Early high-quality bystander CPR
  • Rapid activation of the EMS (or other emergency response) system
  • Effective advanced life support (including rapid stabilization and transport to definitive care and
    rehabilitation)
  • Integrated post-cardiac arrest care

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