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Initiating the Chain of Survival

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Initiating the Chain of Survival

Research shows that BLS can increase the rate of survival for individual patients with cardiac arrest. The rescuer(s) must initiate the Adult Chain of Survival quickly and perform it at a high level of quality.

Key Takeaway

The success of resuscitation for out-of-hospital cardiac arrest (OHCA) relies on the training of community members.

The adult out-of-hospital chain of survival is a framework for first-aid rescuers and lay rescuers who deal with out-of-hospital patients. The out-of-hospital scenario is more complicated than an in-hospital situation because it is an uncontrolled environment with limited resources, such as the number of potential rescuers and BLS equipment availability. The success of resuscitation in out-of-hospital cardiac arrest (OHCA) relies on the training of community members.

Chain of survival.

Chain Of Survival

Adult out-of-hospital cardiac arrest (OHCA) chain of survival involves the following as represented in the graphic depicted above:

  1. Early recognition of cardiac arrest and activation of the emergency response system 
  2. Rapid provision of high-quality CPR
  3. Early defibrillation
  4. Advanced life support interventions by appropriate personnel and transport to appropriate care
  5. Comprehensive post-cardiac arrest care
  6. Rehabilitation assessment and recovery treatment

Adult OHCA chain of survival.

Adult Out-Of-Hospital Cardiac Arrest (OHCA) Chain of Survival

Adult In-hospital cardiac arrest (IHCA) involves mainly the same steps but in a more controlled environment: 

  1. Early recognition, prevention, and treatment of conditions that might result in arrest
  2. Activation of the early response system
  3. Rapid provision of high-quality CPR
  4. Early defibrillation
  5. Comprehensive post-cardiac arrest care
  6. Rehabilitation assessment and recovery treatment

Typically, pediatric patients progress to cardiac arrest after suffering from respiratory distress and respiratory failure or severe dehydration. This population rarely experiences a primary cardiac arrest. Therefore, it is critical to intervene early and prevent the need for resuscitation in infants and children.

Pediatric OHCA chain of survival.

Pediatric Out-Of-Hospital Cardiac Arrest (OHCA) Chain of Survival

Pediatric IHCA chain of survival.

Pediatric In-Hospital Cardiac Arrest (IHCA) Chain of Survival

The pediatric chain of survival stresses the importance of:
  1. Prevention of arrest by early intervention.
  2. Activation of the emergency response system.
  3. Early provision of high-quality CPR.
  4. Advanced life support by appropriate personnel and transport to appropriate care.
  5. Comprehensive post-cardiac arrest care.
  6. Recovery work (rehabilitation) following release from the hospital.

Key Takeaway

The most critical step in the pediatric chain of survival is the prevention of arrest by the early recognition of respiratory distress.