How well do you know the out-of-hospital Chain of Survival for sudden cardiac arrest?
If you don’t know it well, or at all, don’t worry. You’re not alone.
Let’s dig into it, exploring which links in the chain you can use to potentially save a life, and how they fit within the arc of cardiac arrest survival.
The Chain of Survival provides a series of steps that, if performed properly, helps increase the survival chances of individuals who experience a cardiac arrest outside of a hospital setting.
There are six links in the chain – covering the initial bystander response, the professional medical treatment the victim receives, and the recovery period.
The first three links apply to bystanders – non-healthcare professionals near someone experiencing a medical emergency, such as a cardiac arrest. Since most cardiac arrests occur without warning and can strike anyone, anywhere, anytime, bystanders – perhaps like you – are typically the first responders, and a victim’s survival often hinges on whether bystanders intervene quickly and effectively.
Let’s explore the six links.
1. Recognition of cardiac arrest and activation of the emergency response system
A person in cardiac arrest will display tell-tale signs, including:
· Sudden collapse
· Unconsciousness
· Non-responsive to verbal cues or being shaken
· No breathing
· No pulse
Call 911 before you provide medical assistance to the victim. It’s key that emergency medical responders are on their way while you’re helping.
Keep your phone on speaker so you can communicate with the 911 dispatcher. These professionals are trained to assist you – providing you with helpful instructions, asking you the right questions, and keeping you calm and focused.
2. Early cardiopulmonary resuscitation (CPR) with an emphasis on chest compressions
CPR is critical. A cardiac arrest victim’s chances of survival double or triple when CPR is administered in the early minutes after cardiac arrest. Without CPR, the person’s chances of survival, or avoiding irreversible injury, such as brain damage, are significantly reduced.
If you’re not fully trained in bystander CPR, just deliver chest compressions, known as Hands-Only-CPR. Push hard and fast in the center of the victim’s chest.
Chest compressions circulate oxygenated through the body – most importantly to the brain and other vital organs. Hands-only CPR is shown to be especially effective on adults and teens.
Bystander CPR bridges the care gap, keeping vital organs healthy until emergency responders arrive and take over to provide advanced treatment.
3. Rapid defibrillation
Next up is rapid defibrillation, delivered by an automated external defibrillator (AED). This small portable device can fix some abnormal heart rhythms, called arrythmias, the cause of most cardiac arrests.
An AED uses sensors you attach to the victim’s chest to determine whether the heart is in an arrythmia that can be helped by an electric stock. One (or more) is delivered if the AED decides a shock could help.
Since an AED is easy to use, it empowers bystanders to act quickly and confidently during a cardiac arrest. The device has become more common in public, often found in shopping centers, schools, sports venues, and other high-traffic settings.
An AED is typically used in tandem with bystander CPR.
Early activation of emergency services, combined with early CPR and rapid defibrillation, significantly increases the chances of cardiac arrest survival.
4. Advanced life support
Great work in your bystander efforts to help to save a life! If you hadn’t acted quickly, there’s a good chance the advanced life support emergency responders provide wouldn’t help the victim.
Advanced life support may include administering advanced CPR, providing medication, and continuing efforts to stabilize the victim during transport to the hospital.
At the hospital, specialized healthcare providers deliver comprehensive care to optimize the chances of survival. Doctors determine the underlying cause of the cardiac arrest and develop a plan address it.
5. Post-cardiac arrest care
With the initial cardiac emergency addressed, it’s time for post-cardiac arrest care.
Treatment varies depending on each patient’s unique circumstances. Surgery might be needed to remove blockages in the blood vessels that supply blood to the heart, or a surgeon might implant a device in the patient’s chest, an ICD, that detects abnormal heart rhythms and sends an electrical shock to restore normal heart rhythm.
6. Recovery
Last, but certainly not least, we’ve reached the sixth link in the Chain of Survival: recovery.
The American Heart Association added recovery to the Chain of Survival in 2020, emphasizing the “physical, social, and emotional needs of patients and their caregivers after survivors leave the hospital.”
The immediate threat of the cardiac arrest has passed, but the road to recovery – both physical and emotional – has just begun.
The American Heart Association stresses that the physical and mental effects of cardiac arrest can last for months, even years.
Tips the American Heart Association provides for recovery for cardiac arrest patients include:
· Structured assessment for anxiety, depression, posttraumatic stress, and fatigue for survivors and their caregivers.
· Rehabilitation assessment and treatment for physical, neurologic, cardiopulmonary, and cognitive impairments before discharge from the hospital.
· Comprehensive, multidisciplinary discharge planning for cardiac arrest survivors and their caregivers, including medical and rehabilitative treatment recommendations and return to activity/work expectations.
At Starting Hearts, we can provide specific training for making a life-saving difference.
Contact us for more information: info@startinghearts.org
Damini Putti is a healthcare writer based in California.
