Chain of survival

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]


The chain of survival refers to a series of actions that, when put into motion, reduce the mortality associated with cardiac arrest.[1][2] Like any chain, the chain of survival is only as strong as its weakest link.[1][2] The four interdependent links in the chain of survival are early access, early CPR, early defibrillation, and early advanced care.[1]

The chain of Survival


The phrase "chain of survival" was first used as a slogan for the 1988 Conference on Citizen CPR.[3][4] It then appeared in JEMS editorial in August 1989, and the first issue of Currents in Emergency Cardiac Care in 1990.[3] The concept was elaborated in the American Heart Association's 1992 guidelines for cardiopulmonary resuscitation and emergency cardiac care,[5][6] and then echoed by the International Liaison Committee on Resuscitation (ILCOR) in 1997.[1]

Early access

Someone must witness the cardiac arrest and activate the EMS system[1] with an immediate call to 9-1-1[7] (or your local emergency number).

Early CPR

In order to be most effective, bystander CPR should be provided immediately after collapse of the patient.[1][8] Properly performed CPR can keep the heart in VF for 10-12 minutes longer.[2]

Early defibrillation

Most adults who can be saved from cardiac arrest are in ventricular fibrillation or pulseless ventricular tachycardia.[9] Early defibrillation is the link in the chain most likely to improve survival.[1] Public access defibillation may be the key to improving survival rates in out-of-hospital cardiac arrest,[1] but is of the greatest value when the other links in the chain do not fail.[2]

Early advanced care

Early advanced cardiac life support by paramedics is another critical link in the chain of survival.[1] In communities with survival rates > 20%, a minimum of two of the rescuers are trained to the advanced level.[1] In some countries, EMS delivery may be performed by ambulancemen, nurses, or doctors.[2]

See also


  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 "Part 12: From Science to Survival - Strengthening the Chain of Survival in Every Community," Circulation 2000;102:I-358
  2. 2.0 2.1 2.2 2.3 2.4 Bossaert LL (1997). "Fibrillation and defibrillation of the heart". British journal of anaesthesia. 79 (2): 203–13. PMID 9349131.
  3. 3.0 3.1 "The Addition of the Fifth Link in the Chain of Survival to Include Myocardial Infarction,", Accessed July 11, 2007.
  4. "Chain of Survival: Converting a Nation," Citizen CPR Foundation, Accessed July 11, 2007.
  5. Cummins RO, Ornato JP, Thies WH, Pepe PE (1991). "Improving survival from sudden cardiac arrest: the "chain of survival" concept. A statement for health professionals from the Advanced Cardiac Life Support Subcommittee and the Emergency Cardiac Care Committee, American Heart Association". Circulation. 83 (5): 1832–47. PMID 2022039.
  6. "Guidelines for cardiopulmonary resuscitation and emergency cardiac care. Emergency Cardiac Care Committee and Subcommittees, American Heart Association. Part I. Introduction". JAMA. 268 (16): 2171–83. 1992. PMID 1404767.
  7. "Strengthening Each Link in the Chain of Survival," American Heart Association, Accessed July 10, 2007.
  8. Eisenberg MS, Bergner L, Hallstrom A (1979). "Cardiac resuscitation in the community. Importance of rapid provision and implications for program planning". JAMA. 241 (18): 1905–7. PMID 430772.
  9. "Early Defibrillation," Circulation 1997;95:2183-2184.

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