Chain of Survival
The term Chain of Survival provides a helpful metaphor for the Emergency Cardiovascular Care systems concept elements. When the Chain of Survival was first created, it included early recognition, early access, CPR, ventricular fibrillation and ventricular tachycardia defibrillation, and advanced cardiac life support.
This concept was later adopted by the American Heart Association and other health organizations like International Liaison Committee on Resuscitation. Afterward, the Chain of Survival was reevaluated to emphasize the importance of early recognition and response. As aftercare options expanded to include mild therapeutic hypothermia and other treatments, post-cardiac arrest care was added to the Chain of Survival.
Today's latest version includes the recovery link, which emphasizes out-of-hospital cardiac arrest patients and their caregivers' physical, social, and emotional needs after survivors leave the hospital.
What factors affect the survival rates of patients who receive out-of-hospital care?
Out-of-hospital care is an important part of healthcare, as it allows patients to receive treatment in their homes or other settings where they feel comfortable. However, the success of this type of care depends on various factors, including the patient's health status, access to resources, and the quality of care provided.
Out-of-Hospital Chain of Survival Steps
The Chain of Survival refers to the crucial actions required to treat medical emergencies such as heart attack, out-of-hospital cardiac arrest, stroke, and choking or foreign body airway obstruction. The links in the American Heart Association Chain of Survival are:
- Immediate recognition of out-of-hospital cardiac arrest event and activation of the emergency medical response system
- Early, high-quality CPR
- Rapid defibrillation
- Effective, advanced life support
- Integrated post-cardiac arrest care.
The goal of an out-of-hospital cardiac arrest event is to restore a healthy heart rhythm and good neurological outcome. Bystanders can help save a cardiac arrest victim's life and improve patient outcomes by addressing the first three links in the AHA Chain of Survival. Action steps that bystanders can follow are explained below.
Prevention for Pediatric Patient
Prevention has become very effective in hospitals. Therefore, the American Heart Association recommends mirroring that works in adult care. For pediatrics, prevention measures include safety initiatives. These address specific issues that affect children—for example, bicycle helmet laws and SIDS prevention. The goal is to increase bystander rescuer capacity. As a result, we can decrease emergency response times for children ahead of any actual emergency.
Immediate Recognition and Emergency Response Activation
The Chain of Survival is based on a significant fact: Every minute a person does not receive care after a sudden cardiac arrest event, their chance of surviving decreases. Therefore, lay rescuers and emergency medical services must aim to have the fastest possible response. If you are on the scene, you must recognize the cardiac arrest as it occurs and ask another bystander to call 911 before taking any other rescue steps.
Unfortunately, many persons experiencing symptoms that may lead to out-of-hospital cardiac arrest ignore these warning symptoms or, recognizing these warning symptoms correctly, fail to activate the EMS system, preferring to contact relatives instead.
Early, High-Quality CPR
The immediate initiation of bystander CPR can quadruple the chances of survival from an out-of-hospital cardiac arrest event. If untrained, a bystander can perform Hands-only CPR or chest compressions-only CPR.
One of the most commonly held misconceptions about CPR is the idea that there must be at least two breaths between each compression. More than two breaths aren't much help. Therefore, it's much more important that public access defibrillation must be used as soon as possible.
Rescuers should start CPR immediately, with an emphasis on chest compression. Compressing the chest must be performed fast and hard enough.
According to the American Heart Association, the primary components of high-quality CPR are:
- The adequate chest compression depth for adults and children is 2-2.4, and 1.5 for infants.
- The optimal chest compression rate is 100-120 compressions per minute.
- Minimizing interruptions in CPR. If you're slowing down, switch with a fresh rescuer.
- Allowing full chest recoil between compressions
- Avoiding excessive ventilation (rescue breathing)
Early, rapid defibrillation is a critical link in the out-of-hospital chain of survival. It involves applying an automated external defibrillator (AED) to a person who is not breathing normally and whose heart rhythm is irregular. Public access defibrillation is used to restore normal heart rhythm and blood flow. If the heart stops beating, the AED delivers a powerful electric current through the chest wall to start the heart beating again, increasing the chances of survival. Defibrillation within 3–5 mins of collapse can produce a survival rate as high as 50–70%. So if public access defibrillation is available, rescuers must use it as soon as possible.
Advanced Life Support by Healthcare Providers
By this phase, medical professionals have taken over medical care, and advanced care will be provided. Advanced Life Support is a set of life-saving protocols and skills that extend Basic Life Support to further support circulation, airway, and adequate ventilation. Paramedics staff and other healthcare professionals are considered Advanced Life Support trained, including advanced scene management and medical care.
A medical professional must evaluate the cardiac patient for any potential cardiac problems like coronary artery diseases, which must be treated immediately. Therefore, the activation of emergency services comes before anything else.
Post-Cardiac Arrest Care
Cardiac arrest survivors often face physical, cognitive, and psychological challenges after they're discharged from the hospital. They may require ongoing therapies and interventions. Therefore, aftercare is still a crucial component of the chain of survival to ensure a lasting recovery.
Referral to appropriate counseling or other support services, including primary care, should be assessed. Health professionals may also find some circumstances distressing, and their employing organizations should have proper support systems when required.
According to the American Heart Association for Emergency Cardiovascular Care, accurate neurological prognostication in brain-injured cardiac arrest survivors is critical. This ensures that patient with significant potential for recovery is not destined for certain poor outcomes due to care withdrawal. This added step asks care teams to plan to investigate both the causes and the secondary effects of the out-of-hospital cardiac arrest event and ensure treatment continues.
The American Heart Association is committed to supporting research to update both in and out-of-hospital rescue guidelines. This means that the chain will likely improve in the next few years. The current basic life support guidelines still provide a strong outline for thinking about care and remind us that having knowledgeable certified rescuers is supremely important.
What's the role of a bystander in the Chain?
The first three steps of the Chain must often be performed by bystanders, whether they know the cardiac arrest patient. Therefore, it's vital to that you recognize when cardiac arrest occurs and activate the Emergency Medical Services by calling 911.
But performing Cardiopulmonary Resuscitation and public access defibrillation as soon as possible is key to improving outcomes. According to 2014 statistics, about 45% of out-of-hospital cardiac arrest survivors received CPR from bystanders.
Why did the American Heart Association's Chain of Survival change?
The American Heart Association reports that sudden cardiac arrest survival improved around 2012. However, there haven't been substantive survival increases since. Recently, the American Heart Association determined that aftercare received after hospital discharge was missing in surviving sudden cardiac arrest. As a result, recovery in the Chain of Survival was added to the adult and pediatric in-hospital and out-of-hospital chains of survival. Additionally, almost 500 other recommendations were made to increase the cardiac arrest survival rates.
There is no earlier method to reliably identify patients in whom a poor neurological outcome is inevitable, so the American Heart Association's current guidelines for adults also recommend against the withdrawal of life support for at least 72 hours after resuscitation and rewarming from any induced hypothermia.
These changes accompany other notable researched-based changes. For example, the ABC/CAB swap several years ago. Until 2015, the American Heart Association and other health organizations reviewed and updated guidance for CPR every five years.
How can emergency medical personnel improve survival rates for patients who require care outside of a hospital setting?
Emergency medical personnel can improve survival rates for patients who require care outside of a hospital setting by providing prompt and appropriate treatment. This includes assessing the patient's condition, administering necessary medications, and initiating appropriate treatments. Additionally, emergency medical personnel must stay up-to-date on the latest protocols for out-of-hospital care and be prepared to respond quickly to any changes or complications that may arise.
What types of treatments and interventions can be used to improve the survival rate of out-of-hospital patients?
Treatment and interventions that can be used to improve the survival rate of out-of-hospital patients include providing basic life support (such as CPR or defibrillation), administering medications as prescribed, and initiating resuscitation if necessary. Additionally, follow-up care after the patient has been discharged is also important for monitoring their recovery and preventing any further complications.
What are the most common causes of death for patients who do not receive timely out-of-hospital care?
The most common causes of death for patients who do not receive timely out-of-hospital care include cardiac arrest, respiratory failure, stroke, and sepsis. Cardiac arrest is the most common cause of death in out-of-hospital settings, as it is often caused by a lack of oxygen to the heart or an irregular heart rhythm. Respiratory failure is another frequent cause of death in out-of-hospital settings, as it is often caused by a lack of oxygen to the lungs or an inability to breathe effectively. Stroke and sepsis are less common causes of death for out-of-hospital patients but can still result in serious complications and death.
What are the most effective treatment options for patients who require out-of-hospital care?
The most effective treatment options for patients who require out-of-hospital care vary depending on the patient's individual needs and condition. Generally speaking. However, medical personnel should provide basic life support such as CPR, defibrillation, and oxygen if necessary. Medications may also be prescribed to alleviate symptoms or stabilize a patient’s condition in order to prevent further complications. Additionally, follow-up care is important for monitoring a patient’s recovery and preventing any further complications.
How can emergency medical services improve response times and increase the chances of survival for patients in need of out-of-hospital care?
Emergency medical services can improve response times and increase the chances of survival for patients in need of out-of-hospital care by implementing various strategies. First, they can ensure that their personnel is well-trained and knowledgeable on the latest protocols for out-of-hospital care. Additionally, they can invest in rapid response vehicles and communication systems to enable them to respond quickly to medical emergencies. Finally, they can collaborate with local hospitals and other healthcare providers to ensure that the patient is able to receive timely and appropriate care in the event of a medical emergency.
What challenges do emergency medical personnel face when providing care outside of a hospital setting?
Emergency medical personnel face various challenges when providing care outside of a hospital setting. One of the most significant challenges is the lack of access to diagnostic imaging and laboratory testing, which can make it difficult to diagnose and treat patients accurately. Additionally, many out-of-hospital settings do not have the same level of resources as a hospital, such as specialized equipment or medications. Furthermore, emergency medical personnel may also encounter environmental hazards or other challenges due to the location of the patient.
What resources are available to help patients and their families prepare for medical emergencies that occur outside of a hospital setting?
There are several resources available to help patients and their families prepare for medical emergencies that occur outside of a hospital setting. First, it is important for everyone to learn how to recognize the signs and symptoms of a medical emergency so they can take action quickly. Additionally, it is important for families to have a plan in place in case of an emergency, such as knowing who should be contacted and where to go for help. There are many first aid and CPR classes available that can provide individuals with the skills and knowledge needed to respond appropriately in an emergency situation.
What can communities do to support emergency medical personnel and improve survival rates for patients who require out-of-hospital care?
Communities can support emergency medical personnel and improve survival rates for patients who require out-of-hospital care by providing them with the resources they need to respond quickly and effectively. This could include investing in rapid response vehicles, communication systems, specialized training, and other equipment necessary for responding to out-of-hospital emergencies. Additionally, communities can also provide financial support for emergency medical personnel, as well as educational opportunities for the public, in order to raise awareness about the importance of recognizing and responding to medical emergencies.
How does the availability of medical technology and equipment impact the survival rates of out-of-hospital care patients?
The availability of medical technology and equipment is a major factor in the survival rates of out-of-hospital care patients. Access to sophisticated diagnostic tools, such as X-rays, CT scans, ultrasounds, and specialized treatments, can greatly improve the chances of survival for patients in need of emergency care. Additionally, access to advanced medical equipment such as ventilators, defibrillators, and other life-saving devices can also have a significant impact on the survival rates of out-of-hospital care patients.
Successful resuscitation requires quick and coordinated action by trained rescuers, each performing an important role. The chain of survival is an internationally recognized approach to resuscitation and summarizes the essential interventions to improve patient outcomes during medical emergencies. The chain of survival applies to all OHCAs in adults, children, and infants. Early recognition of OHCA, immediate CPR, and early defibrillation remain the key to improving outcomes. The evidence for high-quality post-resuscitation care continues to evolve to improve results further.