The Chain of Survival: CPR Tips to Understand the Links

ProTrainings The Chain of Survival: CPR Tips to Understand the Links

In an emergency situation, when tensions are high and time is important, would you know how to effectively start CPR? By using the chain of survival, CPR can be performed in the correct order, as efficiently as possible. 

The chain of survival is a useful way to remember the essential steps to take when giving someone CPR and is a trope that has been used worldwide over the last three decades. Its aim is to educate people about the key ways to react in an emergency situation. 

Understanding the chain of survival CPR links can ensure you’re prepared to react quickly when someone close to you experiences cardiac arrest. Read on to learn the whats, whys, wheres, and hows of the chain of survival for CPR. 

What Does the Chain of Survival Mean?

We use the term chain of survival in CPR to describe the things that must happen quickly, one after another, to treat someone who has gone into cardiac arrest. 

When a person suffers cardiac arrest, permanent brain damage or death can occur in minutes. In the throes of a medical emergency, it’s easy to panic or to forget what to do. The chain of survival is a handy way of remembering which steps to take, and in which order to take them. 

Why Is the Chain of Survival Important in CPR?

Think of it as a metaphor. Just as a chain is only as strong as its weakest link, the same can be said for the steps to take when someone is experiencing a sudden cardiac arrest. 

The American Heart Association (AHA) has adopted this metaphor as an easy way for members of the public to remember what needs to be done when someone is facing cardiac arrest. Each step is as important as the last. With the chain of survival, CPR is broken into five manageable steps

Where Did the CPR Chain of Survival Come From?

In 1991, the AHA published a paper that gave the chain of survival a name and created the metaphor we still use today. 

Part of the AHA’s work is to make the chain of survival as well-known as possible to the public. That way, when a cardiac arrest occurs, as many people as possible can jump into action and react correctly instead of hesitating to offer help for fear of worsening the situation. 

What Are the Links to the Chain of Survival? 

The AHA and the International Liaison Committee on Resuscitation review CPR guidelines every five years based on the most recent findings. According to the Sudden Cardiac Arrest Foundation, these are the most recent chain of survival guidelines: 

  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. Effective advanced life support
  5. Integrated post-cardiac-arrest care

Finally, an unofficial — but essential — sixth step is recovery, which includes additional treatment, observation, rehabilitation, and psychological support. Each link is crucial for the chain to work. Unfortunately, the majority of patients do not fully recover from cardiac arrest if one (or more) of the links is missing. 

How Have the Chain of Survival CPR Links Changed? 

In the original chain of survival, CPR consisted of four steps. The fifth link was added in recent years as research has unearthed the importance of effective post-cardiac-arrest care. 

In fact, a 2009-10 study in Fukushima, Japan, found that “out-of-hospital cardiac arrest patients with a favorable neurological outcome improved significantly” after step five was introduced to the chain of survival. 

How Do I Know When to Start the Chain of Survival? 

There may be some early signs of cardiac arrest in the minutes or hours before a person loses consciousness. One study by the Smidt Heart Institute suggested a person could suffer shortness of breath up to 24 hours before loss of heart function — but early signs typically vary by sex.

ProTrainings The Chain of Survival: CPR Tips to Understand the Links

According to the study, men were more likely to experience chest pain and women more prone to shortness of breath. Other early signs include fatigue, nausea, and vomiting. 

If in doubt, begin the steps of the chain of survival, CPR, and calling for medical help. 

What Links Should I Know as a Member of the Public? 

The first three chain of survival CPR links are the most important for members of the public to know. They can be performed by any bystander before medical help arrives. Knowing the signs of cardiac arrest is the first step to identifying when someone needs help. 

A common barrier bystanders face when it comes to performing CPR on a victim is simply knowing whether CPR is required. One survey even showed that bystanders are especially reluctant to deliver CPR when the patient is a woman — often in fear that CPR isn’t actually needed.

Knowing the signs of cardiac arrest and how to perform CPR ensures you’re ready to act quickly in an emergency. Even with the chain of survival, CPR must be performed immediately because just a few seconds can make all the difference in increasing a person’s chances of recovery.
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