1st Link: Recognizing Arrest and Activating EMS: Phone Icon

As soon as cardiac arrest is evident, responders activate the emergency medical services (EMS). The steps include:

• The responder must recognize collapse and activate EMS.
• The EMS dispatcher responds and recognizes a potential cardiac arrest, initiating the appropriate emergency response (BLS or ACLS).
• EMS responders arrive and take over care of the patient.

The key to success is the prevention of arrest through early recognition of the event and early initiation of CPR. This can be accomplished by a layperson or by a readily available CPR-trained individual.

EMS must be dispatched quickly. Calling 911 is an easy first step that reduces the wait time for an effective treatment for cardiac arrest patients. Dispatchers must be well trained and able to aid the layperson in determining if a patient is likely to have a cardiac arrest.

2nd Link: High-Quality CPR: Hands Icon

High-quality CPR with excellent chest compressions is the key to saving lives. This is important in the community as well as in hospitals where nonclinical employees should also be aware of high-quality CPR techniques. 

CPR is based on cycles of 30 excellent chest compressions and two breaths with a basic airway, followed by continuous compressions and a breath every 6 seconds with an advanced airway. A critical component is limiting unnecessary interruptions in compressions and ensuring that pauses are limited to 10 seconds or less. 

Research confirms early CPR is necessary to save lives. In OHCA, bystander CPR almost doubles the survival rate. Untrained laypersons should deliver hands-only CPR, which is almost as effective as traditional CPR with breaths in adults. Traditional CPR is more effective for those with respiratory arrest as the cause (especially important in children).

Patients in cardiac arrest do best when they receive immediate CPR and defibrillation within 5 minutes of arrest. In OHCA, more lay people must be trained on providing effective CPR and using automatic external defibrillation (AED) devices to reach these time goals. Also, the EMS dispatcher can question the caller to help ascertain if the patient is likely in cardiac arrest. Once this is determined to be the case, they can provide instructions to untrained laypersons to provide hands-only CPR and help them with AED use.

3rd Link: Defibrillation: Heart Icon

Early defibrillation is key for patients with a shockable rhythm: ventricular fibrillation or pulseless ventricular tachycardia. The goal is to provide defibrillation within 3 to 5 minutes of arrest, as this improves survival rates. For every minute that passes without the use of an AED for defibrillation, the survival rate decreases by up to 10% (although this decline is mitigated by interval CPR).

4th Link: Excellent Advanced Care: Ambulance Icon

Excellent care for patients with cardiac arrest requires the integration of BLS and ACLS. Outside of the hospital, EMS responders must be well trained in BLS, but at least one, and preferentially two, EMS responders should be able to provide ACLS. The participation of two or more trained ACLS responders is associated with at least a 20% survival rate in patients with VF.⁴

5th Link: Post-arrest Treatment: Bed Icon

Following the acute management of cardiac arrest, integrating multiple areas of care, such as cardiovascular, metabolic, and neurologic care, is instrumental in increasing survival rates following ROSC. 

The primary goals of post-arrest treatment are to:

1. Maintain cardiovascular perfusion.
2. Transport of the OHCA patient to a facility that can maintain an appropriate level of care or the transport of an in-hospital cardiac arrest patient to an intensive care unit.
3. Identify and manage the cause of cardiac arrest while preventing recurrence.

The secondary goals of post-arrest treatment are to: 

1. Maintain a body temperature that optimizes neurologic function and survival.
2. Manage treatment of existing acute coronary syndrome (ACS).
3. Manage mechanical ventilation and reduce organ injury.
4. Maintain organ function and take steps to decrease organ injury.
5. Determine recovery prognosis.
6. Transition to an appropriate rehabilitation service.

6th Link: Recovery

The final link includes rehabilitation assessment and treatment before hospital discharge. This recovery link involves assessing the needs and providing rehabilitation services for both the patient and their family. 

These efforts involve assessment of:

• Cardiopulmonary status
• Neurologic status
• Return to work
• Post-traumatic stress
• Fatigue

Another example of a resuscitation chain of survival links the community to EMS and EMS to the hospital. This chain of survival recognizes that cardiac arrest can occur anywhere at any time, and the SOC must be able to manage cardiac arrests wherever they happen.

Patient’s Point of Entry