Survival chains allow effective organization and integration of the necessary actions to treat cardiac arrest. This is achieved using evidence-based techniques and effective strategies. 

Benefits of Teams

IHCAs carry a high rate of mortality—it comes with a 24% survival rate— despite the advances that have been made in medical care. Mortality is even worse for those with arrhythmias that are neither VF nor pulseless VT, which make up about 82% of IHCAs.

Importantly, most patients with IHCA have signs and symptoms before the onset of cardiac arrest. Consequently, there may be a time window within 8 hours of the event in which preventative measures can be taken. By taking advantage of this prearrest window, providers may be able to reduce the percentage of IHCA patients who ultimately die following ICU admission after ROSC.

IHCA Teams

Rather than focusing on hospital teams that respond to cardiac arrest, hospitals have moved to more preventative teams that identify and manage prearrest signs to prevent cardiac arrests from ever happening. Currently, the rate of death is 75% once an IHCA occurs. By preventing arrest, many patients can be saved. These systems must shift to viewing IHCAs as a failure to prevent rather than random occurrences. 

Rapid Response Algorithms

Hospitals have begun to make this shift toward providing a more rapid response over the past 10 years. The focus is to bring critical care services to general care wards and prevent the occurrence of acute cardiac events. 

Rapid response requires: 

• early assessment and triage
• rapid response teams such as RRTs and METs
• excellent monitoring
• a supportive administration

Rapid response teams can be activated by many members of the health care team (nurses, respiratory therapists, physicians) as well as family members who may notice a change in the patient. 

There are also specific criteria that can trigger rapid response:

• airway emergency
• bradypnea < 6 beats/minute or tachypnea > 30 breaths/minute
• bradycardia < 40 beats/minute or tachycardia > 140 beats/minute
• systolic BP < 90 mm Hg
• hypertensive crisis
• a sudden change in consciousness level
• a change in mental state, agitation
• a seizure
• decreased urine output
• subjective concerns.

Rapid Response Teams (RRTs) and Medical Emergency Teams (METs)

Regardless of the name of the team, the rapid response algorithm depends on teams that focus on early evaluation of patients and quick activation of the system response. Team members include critical care and emergency physicians who are adept at managing life-threatening conditions and identifying and treating patients suffering from IHCA. Consistently implementing these teams has shown a 17–65% reduction in cardiac arrest rates. 

Additionally, the use of these teams can result in:

• Reduced emergent ICU transfers
• Reduced ICU admissions and hospital stays
• Reduced morbidity and mortality postoperatively
• Increased survival rates 

Implementing the Rapid Response Algorithm

Beginning a new system in a hospital requires buy-in from clinicians and administrators. The clinical focus should be on efficiency and education as well as ongoing review. Administrators must obtain financial support and foster a shift in the hospital culture. Of paramount importance is the emphasis on patient safety and the prevention of harm rather than reactionary care.  

Regional Cardiac Care Systems 

Patient numbers matter. Hospitals with higher post-cardiac arrest ICU patient volumes have better survival rates following cardiac arrest than those treating lower patient volumes.⁵