Chain of Survival

Adult and Pediatric Out of Hospital Cardiac Arrest

EARLY ACTIVATION
OF EMERGENCY RECOVERY
RESPONSE
EARLY ACTIVATION OF EMERGENCY RESPONSE

Ideally, someone must recognize

an impending cardiac arrest or
otherwise witness the cardiac
PERFORM EARLY POST-CARDIAC arrest and activate the EMS
CPR ARREST CARE system as early as possible with an
immediate call to the emergency
services. If a person is unresponsive
and not breathing normally, call
911. Follow the emergency
DEFIBRILLATE ADVANCED LIFE dispatcher’s instructions.
WITH AED SUPPORT
EARLY ACTIVATION
OF EMERGENCY RECOVERY
RESPONSE
PERFORM EARLY CPR
The American Heart Association re-
emphasized the importance of
more bystanders performing hands-
PERFORM EARLY POST-CARDIAC only CPR until EMS personnel arrive
CPR ARREST CARE because, at present, fewer than
40% of people who have an out-
of-hospital cardiac arrest receive
CPR from a bystander. Properly
performed CPR can keep the heart
DEFIBRILLATE ADVANCED LIFE in a shockable rhythm for 10–12
WITH AED SUPPORT minutes longer.
 DEFIBRILLATE WITH AED
EARLY ACTIVATION Most adults who can be saved from
OF EMERGENCY RECOVERY cardiac arrest are in ventricular
RESPONSE fibrillation or pulseless ventricular
tachycardia, which means their heart
has fallen out of rhythm. While CPR
keeps blood flowing artificially, rapid
defibrillation is the only way to restart
the heart and reset it to a healthy
PERFORM EARLY POST-CARDIAC rhythm.
CPR ARREST CARE

ADVANCED LIFE SUPPORT

Some ACLS ambulance providers
DEFIBRILLATE ADVANCED LIFE will administer medications to
WITH AED SUPPORT manage pain, arrhythmias, shock,
and pulmonary congestion;
monitor the heart rhythm to
identify any potentially lethal
cardiac arrhythmias; or initiate
transcutaneous pacing.
 POST CARDIAC ARREST CARE AND RECOVERY
EARLY ACTIVATION The American Heart Association
OF EMERGENCY RECOVERY added the recovery phase as the
RESPONSE sixth link in the chain of
survival. Recovery consists of
cardiac arrest survivors receiving
treatment, surveillance, and
rehabilitation at a hospital.
PERFORM EARLY POST-CARDIAC
CPR ARREST CARE

POST CARDIAC ARREST CARE AND RECOVERY

A patient’s recovery from cardiac
DEFIBRILLATE ADVANCED LIFE arrest continues long after their initial
SUPPORT hospitalization following the event, so
WITH AED the American Heart Association
recommended in their 2020
guidelines that patients have formal
assessment and support for their
physical, cognitive, and psychosocial
need.
Pediatric Chain of
Survival
Emergencies in children and
infants are not usually caused by
the heart. Children and infants
most often have breathing
problems that trigger cardiac
arrest. The first and most
important step of the Pediatric
Chain of Survival is prevention.
 PREVENT ARREST
PREVENT ARREST RECOVERY Prevention of injury and
arrest is an effective and
important step in reducing
death and improving
health care for children.

ACTIVATE EMS POST-CARDIAC

ARREST CARE

ACTIVATE EMS
When OHCA was
ADVANCED LIFE happened, the emergency
PERFORM EARLY medical services should be
CPR SUPPORT
notified quickly as possible
by dialing 911.
PREVENT ARREST RECOVERY

PERFORM EARLY CPR

By stander should initiate cpr

immediately. For an infant, lone
POST-CARDIAC rescuers should compress the
ACTIVATE EMS sternum with 2 fingers and
ARREST CARE
between the nipples. Do not
compress over the xiphoid or
ribs. Rescuers should compress
at least one third the depth of
ADVANCED LIFE the chest, or about 4 cm.
PERFORM EARLY
CPR SUPPORT
PREVENT ARREST RECOVERY

PEDIATRIC ADVANCE LIFE SUPPORT

Early advanced cardiac life
support by paramedics is
another critical link in the chain
ACTIVATE EMS POST-CARDIAC of survival. In communities with
ARREST CARE survival rates > 20%, a minimum
of two of the rescuers are
trained to the advanced level.
PALS providers give life saving
medication that can increase
PERFORM EARLY ADVANCED LIFE the survival rates of children.
CPR SUPPORT
PREVENT ARREST RECOVERY

POST CARDIAC ARREST CARE AND RECOVERY

Post–cardiac arrest care is a

critical component of advanced
life support. Most deaths occur
POST-CARDIAC during the first 24 hours after
ACTIVATE EMS
ARREST CARE cardiac arrest. The best hospital
care for patients with ROSC after
cardiac arrest is not completely
known, but there is increasing
interest in identifying and
optimizing practices that are likely
PERFORM EARLY ADVANCED LIFE to improve outcomes
CPR SUPPORT