Chain of survival
Encyclopedia
The chain of survival refers to a series of actions that, when put into motion, reduce the mortality associated with cardiac arrest
. Like any chain, the chain of survival is only as strong as its weakest link. The four interdependent links in the chain of survival are early access, early CPR, early defibrillation, and early advanced cardiac life support
and emergency cardiac care, The International Liaison Committee on Resuscitation (ILCOR) echoed the concept in 1997.
as early as possible with an immediate call to the emergency services. Unfortuately, many persons experiencing symptoms (for example, angina) that may lead to a cardiac arrest ignore these warning symptoms or, recognising these warning symptoms correctly, fail to activate the EMS system, preferring to contact relatives instead (the elderly often contact their adult offspring rather than contact emergency services).
for 10–12 minutes longer.
or pulseless ventricular tachycardia
. Early defibrillation is the link in the chain most likely to improve survival. Public access defibillation 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.
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. In some countries, EMS delivery may be performed by ambulance officers, paramedics, nurses, or doctors.
Cardiac arrest
Cardiac arrest, is the cessation of normal circulation of the blood due to failure of the heart to contract effectively...
. Like any chain, the chain of survival is only as strong as its weakest link. The four interdependent links in the chain of survival are early access, early CPR, early defibrillation, and early advanced cardiac life support
Advanced cardiac life support
Advanced cardiac life support or Advanced Cardiovascular Life Support refers to a set of clinical interventions for the urgent treatment of cardiac arrest and other life threatening medical emergencies, as well as the knowledge and skills to deploy those interventions.Extensive medical knowledge...
Background
The "chain of survival" metaphor was developed by Mary Newman, first used as a slogan for the 1988 Conference on Citizen CPR, and first described in an article she wrote for the Journal of Emergency Medical Services in 1989 (The Chain of Survival Concept Takes Hold. JEMS 1989;14:11-13) and in an editorial she wrote for the first issue of Currents in Emergency Cardiac Care in 1990 (The Chain of Survival: Converting a Nation,Currents 1990;1(1):3.)."The Addition of the Fifth Link in the Chain of Survival to Include Myocardial Infarction," ChestPainCenters.org, Accessed July 11, 2007. The American Heart Association adopted the concept and elaborated on it in its 1992 guidelines for cardiopulmonary resuscitationCardiopulmonary resuscitation
Cardiopulmonary resuscitation is an emergency procedure which is performed in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person in cardiac arrest. It is indicated in those who are unresponsive...
and emergency cardiac care, The International Liaison Committee on Resuscitation (ILCOR) echoed the concept in 1997.
Early access
Ideally, someone must recognise an impending cardiac arrest or otherwise witness the cardiac arrest and activate the EMS systemEmergency medical services
Emergency medical services are a type of emergency service dedicated to providing out-of-hospital acute medical care and/or transport to definitive care, to patients with illnesses and injuries which the patient, or the medical practitioner, believes constitutes a medical emergency...
as early as possible with an immediate call to the emergency services. Unfortuately, many persons experiencing symptoms (for example, angina) that may lead to a cardiac arrest ignore these warning symptoms or, recognising these warning symptoms correctly, fail to activate the EMS system, preferring to contact relatives instead (the elderly often contact their adult offspring rather than contact emergency services).
Early CPR
In order to be most effective, bystander CPR should be provided immediately after collapse of the patient. Properly performed CPR can keep the heart in a shockable ventricular fibrillationVentricular fibrillation
Ventricular fibrillation is a condition in which there is uncoordinated contraction of the cardiac muscle of the ventricles in the heart, making them quiver rather than contract properly. Ventricular fibrillation is a medical emergency and most commonly identified arrythmia in cardiac arrest...
for 10–12 minutes longer.
Early defibrillation
Most adults who can be saved from cardiac arrest are in ventricular fibrillationVentricular fibrillation
Ventricular fibrillation is a condition in which there is uncoordinated contraction of the cardiac muscle of the ventricles in the heart, making them quiver rather than contract properly. Ventricular fibrillation is a medical emergency and most commonly identified arrythmia in cardiac arrest...
or pulseless ventricular tachycardia
Ventricular tachycardia
Ventricular tachycardia is a tachycardia, or fast heart rhythm, that originates in one of the ventricles of the heart...
. Early defibrillation is the link in the chain most likely to improve survival. Public access defibillation 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.
Early advanced care
Early advanced cardiac life supportAdvanced cardiac life support
Advanced cardiac life support or Advanced Cardiovascular Life Support refers to a set of clinical interventions for the urgent treatment of cardiac arrest and other life threatening medical emergencies, as well as the knowledge and skills to deploy those interventions.Extensive medical knowledge...
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. In some countries, EMS delivery may be performed by ambulance officers, paramedics, nurses, or doctors.
See also
- Cardiac arrestCardiac arrestCardiac arrest, is the cessation of normal circulation of the blood due to failure of the heart to contract effectively...
- Cardiac Arrest Registry to Enhance Survival
- Cardiopulmonary resuscitationCardiopulmonary resuscitationCardiopulmonary resuscitation is an emergency procedure which is performed in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person in cardiac arrest. It is indicated in those who are unresponsive...
- DefibrillationDefibrillationDefibrillation is a common treatment for life-threatening cardiac arrhythmias, ventricular fibrillation and pulseless ventricular tachycardia. Defibrillation consists of delivering a therapeutic dose of electrical energy to the affected heart with a device called a defibrillator...
External links
- "The Links in the Chain of Survival," American Heart AssociationAmerican Heart AssociationThe American Heart Association is a non-profit organization in the United States that fosters appropriate cardiac care in an effort to reduce disability and deaths caused by cardiovascular disease and stroke. It is headquartered in Dallas, Texas...
- "Chain of Survival: Converting a Nation," Citizen CPR Foundation
- http://www/sca-aware.org