The Chain of Survival

In the early 1990s, the American Heart Association (AHA) introduced the concept of the Chain of Survival as part of its CPR and Emergency Cardiac Care (ECC) guidelines. This chain represents a series of critical actions that significantly improve survival rates for victims of Sudden Cardiac Arrest (SCA). Each “link” in the chain plays a vital role in ensuring timely intervention and increasing the chances of recovery.

In-Hospital Cardiac Arrest (IHCA)

For cardiac arrests occurring in a hospital setting, the Chain of Survival consists of the following five key links:

• Prevention, Supervision, and Early Intervention: Monitoring, preventing, and treating conditions that may lead to cardiac arrest.
• Early Recognition and Activation of Emergency Response: Quickly identifying cardiac arrest and activating the hospital’s Emergency Response System (ERS).
• Immediate High-Quality CPR: Performing CPR with an emphasis on effective chest compressions.
• Rapid Defibrillation (AED Use): Delivering a shock with an Automated External Defibrillator (AED) as soon as possible.
• Advanced Life Support (ALS) and Post-Arrest Care: Providing advanced medical interventions and post-cardiac arrest treatment.

Out-of-Hospital Cardiac Arrest (OHCA)

For cardiac arrests that occur outside of a hospital, survival depends on rapid response from bystanders, emergency responders, and healthcare professionals. The Chain of Survival for OHCA includes:

• Immediate Recognition and Activation of Emergency Response: Identifying cardiac arrest and calling 911 or the appropriate emergency number.
• Early CPR with Emphasis on Chest Compressions: Providing high-quality chest compressions as soon as possible.
• Rapid Defibrillation (AED Use): Using an AED to deliver a shock if needed.
• Advanced Life Support (ALS) and Post-Arrest Care: Emergency medical services (EMS) providing advanced care and stabilization.
• Comprehensive Post-Cardiac Arrest Treatment: Ensuring hospital-based care, including targeted temperature management and neurological evaluation.

Each link in the Chain of Survival is critical. The faster these actions are taken, the higher the chance of survival and recovery.