When we originally wrote about the CPR pediatric chain of survival, the American Heart Association’s model (from 1992) had four main steps: Early access, Early CPR, Early Defibrillation, and Early Advanced care.
As of the AHA’s last update in 2020, the adult and pediatric versions of the Out-of-hospital Chain of Survival now each have six steps:
The Adult Out-of-Hospital Chain of Survival Steps Are:
- Activation of Emergency Response System
- High-Quality CPR (emphasis on chest compressions)
- Rapid Defibrillation
- Advanced Resuscitation by healthcare providers
- Post-Cardiac Arrest Care
- Recovery
The Pediatric Out-of-Hospital Chain of Survival Steps are:
- Prevention
- Activation of Emergency Response
- High-Quality CPR (emphasis on chest compressions)
- Advanced Resuscitation by healthcare providers
- Post-Cardiac Arrest Care
- Recovery
Why did the AHA’s Chain of Survival change?
These changes accompany other notable researched based changes. For example, the ABC/CAB swap several years ago. Until 2015 the AHA reviewed and updated guidance for CPR every five years. Starting in 2015, the organization changed to a more continuous update model. This allows change on guidance as research reveals new, important science. Therefore, we don’t have to wait for the next revision period to arrive.
The AHA reports that sudden cardiac arrest survival improved up to around 2012. However, there haven’t been substantive survival increases since. Recently, the AHA determined that one major factor in surviving sudden cardiac arrest was missing, the after-care received after hospital discharge. As a result, a sixth link in the Chain of Survival (“Recovery”) was added. It’s now included in the adult and pediatric in-hospital and out-of-hospital chains of survival. In addition, almost 500 other recommendations were made to increase survival rates.
What are the Steps of the Out-of-Hospital Chain of Survival?
The Adult and Pediatric Chains of Survival are very similar. Therefore, we’re addressing the two steps that vary between the two. They are Prevention (Pediatric Chain) and Rapid Defibrillation (Adult).
Prevention (Pediatric Chain Only)
Obviously prevention measures matter for everybody. In fact, they have become very effective in hospitals. Therefore, AHA recommends mirroring that work in adult care. For pediatrics, prevention measures include “safety initiatives.” These address specific issues that affect children. For example, bicycle helmet laws and SIDS prevention. The goal is to increase lay-rescuer capacity. As a result, we can decrease emergency response times for victims ahead of any actual emergency.
Recognition and Emergency Response Activation
The Chain of Survival is based on a very important fact: Every minute that a person does not receive care after sudden cardiac arrest, their chance of surviving decreases. Undoubtedly, the goal is have the fastest possible response, both by lay rescuers and emergency services.
For lay-rescue and emergency notification to be timely, it’s important that bystanders in cardiac events are able to recognize the emergency as it occurs. Once they do, they should assign another bystander (if any) to call 911 before taking any other rescue steps.
Early, High-Quality CPR (Emphasis on Chest Compressions)
As we’ve written recently, one of the most common misconceptions about CPR relates to the number of breaths a victim needs. Any more than 2 breaths after 30 compressions isn’t much help. It’s much more important that an AED is used as fast as possible. If one is not available, then CPR should be started just as quickly. It’s especially important that it is performed fast and hard enough.
According to the AHA, the primary components of “high quality CPR” are:
- Adequate chest compression depth (adults: 2-2.4 inches; children: 2; infants: 1.5)
- Optimal chest compression rate (100-120 per minute)
- Minimizing interruptions in CPR (if you’re slowing down, switch with a fresh rescuer)
- Allowing full chest recoil between compressions
- Avoiding excessive ventilation
Rapid Defibrillation (Adult)
If regular heart function can be restored before the existing in-bloodstream oxygen is depleted, chances of survival can be much higher. If an AED is available, it should be put to use as soon as possible.
Advanced Resuscitation by Healthcare Providers
It’s imperative to get quality lay-rescuer intervention as fast as possible. Likewise, it is equally vital to get professional care at the earliest possible moment. The victim needs to be assessed for variety of possible sudden cardiac arrest problems, which need to be addressed immediately. For this reason, this is why “activation of emergency response” comes before CPR.
Post-Cardiac Arrest Care
By this phase, care has been taken over by medical professionals. History and research have taught some very specific lessons. We have learned about what care can improve outcomes for different people suffering sudden cardiac arrest for different reasons. Therefore, aftercare is still a critical component to ensuring a lasting recovery.
Recovery
According to the AHA, “Accurate neurological prognostication in brain-injured cardiac arrest survivors is critically important. This ensures that patients with significant potential for recovery are not destined for certain poor outcomes due to care withdrawal.”
This added step asks care teams to plan to investigate both the causes and the secondary effects of the cardiac arrest and ensure treatment continues.
The AHA’s is committed to support research. LIkewise, they dedicated to update both in and out-of hospital rescue guidelines. Consequently, this means that the Chain of Survival is likely to be improved again in time. The current version still provides a strong outline for how to think about care. It also reminds us that having a bank of knowledgeable, certified lay-person rescuers is supremely important.
Are you ready to get your staff certified in CPR? Does your organization need training for other lifesaving measures? Find out about EMC’s training courses available here.
Are you looking for an AED to provide for the Rapid Defibrillation step in the out-of-hospital Chain of Survival at your place of business? Shop for AEDs here.
** Note: This article is informative. The information was accurate at the time of writing. It is in not way a replacement for training.
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