The Chain of Survival from Sudden Cardiac Arrest

Research shows that the earlier an SCA victim is helped, the greater the chance of survival. Schools can play a critical role by taking the first steps in the well-known

Sudden cardiac arrest (SCA) is a sudden and unexpected pulseless status caused by a disturbance in the heart'south electric activity. The electrical disturbance may be due to a heart attack, a severe imbalance of electrolytes, an inherited genetic mutation that predisposes the heart to electric abnormalities, an electric shock (e.g., from lightning), or blunt force trauma to the chest leading to commotio cordis. Symptoms include an almost instantaneous loss of consciousness and collapse. The treatment goal for SCA is to restore a salubrious center rhythm and skilful neurological effect. (Graham R, 2015)

SCA strikes approximately 326,200 (Mozaffarian D, 2015) to 395,000 (Graham R, 2015) individuals outside hospitals each year in the U.S., including an estimated 6,328 people less than 18 years of age (Mozaffarian D, 2015). On average, about one in 10 victims survives (Graham R: 6%; Mozaffarian D: 10.half-dozen%), though some high performing communities have achieved survival rates of more than 60% for specific types of cardiac abort (Graham R, 2015).

The majority of people who survive SCA invariably receive immediate assistance from bystanders at the scene. The time between the onset of arrest and the provision of care determines the likelihood of survival. If treatment is not provided within 10 minutes, the survival charge per unit is close to zilch. Because minutes count, the public plays a crucial role in saving lives threatened by SCA. (Graham R, 2015)

The "Chain of Survival" refers to the chain of events that must occur in rapid succession to maximize the chances of survival from SCA. When the Concatenation of Survival metaphor was first created and described, information technology included early on recognition, early access, early CPR, early on defibrillation and early advanced life support (Newman M, 1989, 1990). The metaphor was a simple fashion to brainwash the public about its vital role in helping SCA victims, suggesting that each link is critical and interdependent, and the Chain of Survival is but equally strong as its weakest link.

The concept was after adopted by the American Center Association (Cummins R, 1991) and other health organizations. Subsequently, the Chain of Survival was revisited to emphasize the importance of early recognition and response (Newman M, Bahr R, 1998).

Every bit post-resuscitation care options expanded to include balmy therapeutic hypothermia and other treatments, some other link, integrated mail-cardiac arrest intendance, was added to the Chain (Hazinski M, 2010).

Today, the links in the American Eye Association version of the Concatenation of Survival are:

  1. Immediate recognition of cardiac arrest and activation of the emergency response system
  2. Early CPR with an emphasis on chest compressions
  3. Rapid defibrillation
  4. Constructive advanced life back up
  5. Integrated postal service-cardiac arrest care.

Bystanders can help salve lives by addressing the first iii links in the Chain of Survival. Action steps for bystanders are described below.

BYSTANDERS

ane. Immediate recognition of cardiac abort and activation of the emergency response system

Action steps

  • Recognize the emergency and decide to act.
  • Call 9-one-1 or the local emergency number, activate the on-site emergency response system (e.g., by phone or text), and send someone to retrieve the nearest automated external defibrillator (AED). If the rescuer is alone, he or she should recollect the AED immediately.

Notes

  • A medical emergency can exist ambiguous, confusing and frightening, which can delay effective action (Braslow A). Nevertheless, information technology is critical to make the decision to aid and take action immediately.
  • If the victim is unresponsive, non breathing or not breathing normally, he or she could be in cardiac abort. The SCA victim may experience several seconds of seizure action and agonal breathing, or gasping. The rescuer should doubtable cardiac arrest if the victim is not breathing usually or merely gasping.

ii. Early CPR with an emphasis on chest compressions

Action steps

  • Start CPR immediately.

Notes

  • Decreasing the time between cardiac arrest onset and the first chest pinch is critical to survival (Graham, 2015).
  • If the eyewitness is not trained in CPR, he or she should provide hands-only or compression-only CPR by pushing hard and fast on the center of the chest at a rate of at least 100 compressions per minute.
  • For adult victims, the compression depth should exist at least ii inches. For young victims (age 1-8) the compression depth should be about two inches, or nearly one-third the diameter of the chest.
  • The rescuer should permit the chest to recoil completely between compressions.
  • The rescuer should continue CPR until an AED is gear up for use or EMS providers take over care of the victim.
  •  In the event the eyewitness is trained and good in CPR, he or she should provide thirty compressions followed by ii breaths and repeat this bicycle until an AED is set up for utilize or EMS providers take over care of the victim.
  • Emergency dispatchers in many EMS systems will coach bystanders in their efforts to save lives. They will guide rescuers through compression-only CPR, and in the event of an asphyxial arrest such equally drowning, dispatchers volition likewise provide guidance on rescue breathing.

3. Rapid defibrillation

Activity steps

  • As soon as an AED is bachelor, the rescuer should position the device next to the patient, plough it on, and follow visual and vocalization prompts. He or she should then attach the electrode pads to the victim'south blank chest as shown in the diagram on the pads. If a shock is advised, the rescuer should be sure no 1 is touching the victim and and so printing the stupor push.

Notes

  • If a shock is needed, the device will instruct the rescuer to press the shock button. In fully automatic devices, the stupor volition be delivered automatically.
  • AEDs are designed for use by untrained laypersons. They are safe, effective, and intuitive devices that will non shock a victim unless a shock is needed to restore a normal heartbeat. They cannot harm the victim.
  • AEDs are safe for use with children. If the kid is age one-viii and a pediatric dose-attenuator is available, the rescuer should utilise it. If this adapter is not bachelor, the rescuer should use a standard AED.

EMERGENCY RESPONDERS

The ii remaining links in the Chain of Survival refer to actions that should be taken by professional person responders. They include advanced life support and integrated post-cardiac arrest intendance.

4. Constructive advanced life support

Advanced life support refers to loftier-quality CPR, early defibrillation, and employ of devices and drugs.

5. Integrated postal service-cardiac arrest care

Integrated mail service-cardiac arrest care refers to a comprehensive, multidisciplinary system of intendance including mild therapeutic hypothermia and other treatments.

SUMMARY

Cardiac arrest handling is a community issue requiring a wide range of people to be prepared to human action—including bystanders, family members, first responders, emergency medical personnel, and other healthcare providers. Bystander CPR and AED use can significantly improve outcomes from cardiac arrest (Graham, 2015).

-Mary M. Newman, MS

References

Braslow A., Principal Investigator, U. South. Department of Transportation & Metropolitan Dade County Function of Trauma Services (1992). National Standard Curriculum for Bystander Care, Washington, DC: U.s.
Cummins RO, Ornato JP, Thies WH, et al. Improving survival from sudden cardiac arrest: the "chain of survival" concept: A statement for health professionals from the Avant-garde Cardiac Life Support Subcommittee and Emergency Cardiac Care Committee, American Heart Association . Circulation 1991;83:1832-1847.
Graham R, Eisenberg M, et al. Strategies to amend survival: A time to human activity. Institute of Medicine Written report, pre-publication re-create. Come across SCA Foundation summary hither: http://www.sca-aware.org/sca-news/u.s.a.-cardiac-arrest-survival-rates-around-half-dozen-percent-for-those-occurring-outside-of-a-hospital
Hazinski, One thousand, editor. 2010 AHA Guidelines for CPR and ECC
Mozaffarian D, et al. Heart Disease and Stroke Statistics—2015 Update. Circulation. 2015;131:00-00. Run across SCA Foundation summary here: http://www.sca-aware.org/sca-news/aha-releases-2015-middle-and-stroke-statistics
Newman, MM, The chain of survival takes hold. Journal of Emergency Medical Services 1989;14:11-13.
Newman, MM, The chain of survival: converting a nation (editorial). Currents in Emergency Cardiac Intendance 1990;one(one):3.
Newman, MM. The chain of survival revisited: The emergence of early recognition as the unsung vital link. Journal of Emergency Medical Services 1998;23(5).