The Chain of Survival is a four-step process for providing treatment to victims of sudden cardiac arrest (SCA). It was developed by the American Heart Association (AHA) in 1990 after several decades of research into SCA and was designed in recognition of the fact that most episodes of SCA occur outside of a hospital, with death occurring within minutes of onset without treatment. Quick execution of each and every link is critical because the chances of survival decrease 7 to 10% with each passing minute.
More people can survive SCA if the following steps occur in rapid succession:
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Immediate call crucial. The sooner 911 or your local emergency number is called the sooner early advanced life support arrives. A delay of just a few minutes could prove fatal.
Sets Chain of Survival in motion. Calling 911 gives the next two links, CPR and Early Defibrillation, the greatest opportunity for success.
Early CPR. Once an SCA victim collapses and a bystander calls 911, the next step in the Chain is to perform Cardiopulmonary Resuscitation (CPR) if you are trained, or to find someone who is.
Buys time: During SCA, the heart twitches irregularly, most often due to ventricular fibrillation (VF), and cannot pump oxygenated blood efficiently to the brain, lungs, and other organs. The victim quickly stops breathing and loses consciousness. Prompt CPR can help sustain life during VF. The mouth-to-mouth breathing and chest compressions help oxygenated blood flow to the person's brain and heart until an AED can be used to attempt to restore normal heart pumping or advanced medical personnel arrive.
Ineffective by itself: Only when combined with early defibrillation and early advanced care can CPR significantly increase an SCA victim's chance for long-term survival.
CPR alone cannot fully resuscitate a person in SCA because it does nothing to restore normal heart rhythm
While better than no treatment, the survival rate for victims in SCA treated by CPR alone is very small (between 2 to 5%);
The longer CPR is performed, the less the chance of survival.
Strength of link depends on increased training. Lay people initiate CPR in more than half of SCA cases in which someone has witnessed the incident. The strength of this link is dependent on the number of lay people trained in CPR and the number of training programs in your schools and community.
Early Defibrillation. Most victims of SCA need an electric shock called defibrillation to restore the heart to a regular rhythm.
Most critical link: Although CPR can sustain life for a short time, it must be followed within minutes by early defibrillation.
Each minute that defibrillation is delayed reduces the victim's chance of survival by about 10 percent.
Not all rescues involving an AED are successful, but where AEDs are deployed widely and used quickly, survival rates of 50% or higher have been reported - a far cry from the 2-5% survival rates for CPR alone.
Early defibrillation is thus recognized as the most critical step in restoring cardiac rhythm and resuscitating a victim of SCA.
Strength of link depends on AED availability. Almost a third of the deaths from sudden cardiac arrest can be prevented if an AED id available for immediate use at the time of the emergency. Unfortunately, AEDs are not yet widely in use, especially in schools and by youth sports programs. As a result, many youth sports athletes die each year that might have been saved by an AED.
Early Advanced Life Support. The fourth link in the Chain of Survival is advanced care. Paramedics and other highly trained EMS personnel provide this care, which can include basic life support, defibrillation, administration of cardiac drugs, and the insertion of endotracheal breathing tubes (intubation).
Helps maintain normal heart rhythm after defibrillation: Advanced care can help the heart in VF respond to defibrillation and maintain a normal rhythm after successful defibrillation.
Allows monitoring on way to hospital: The trained EMS personnel monitor the patient closely on the way to the hospital, where more definitive diagnostic evaluation can occur.
SCA accounts for at least 350,000 deaths each year in the United States and some authorities believe the number is much higher. Whatever the accurate number, cardiac arrest kills more people than all forms of cancer combined.
Following the Cardiac Chain of Survival dramatically increases the survival rates for SCA victims:
CPR and AED Used Within 8 Minutes: 20 % Chance of Survival. When CPR and defibrillation are provided within eight minutes of an episode, a person's chance of survival increases to 20%.
CPR and AED Within 4 Minutes/EMS Within 8 Minutes: 40% Chance of Survival. When these steps are provided within four minutes and a paramedic arrives within eight minutes, the likelihood of survival increases to over 40%.
Defibrillation Within 5 To 7 Minutes: 49% Survival Rate. According to the AHA, the survival rate from SCA is as high as 49% where defibrillation occurs within 5 to 7 minutes of collapse.
Survival Rates As High As 64%. The AHA also reports that after AEDs were placed at Chicago's O'Hare and Midway Airports, 9 out of 14 SCA victims (64%) were revived with an AED and had no permanent neurological damage.
If nothing is done for a cardiac arrest victim, he is probably going to die. Even with prompt CPR he is probably going to die before the ambulance arrives. Defibrillation applied shortly after his collapse gives him a fair chance of survival. What better reason could there be for implementing AED programs?
Article Updated: July 6, 2006 Published March 4, 2004
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