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.

More people can survive sudden cardiac arrest when a particular sequence of events occurs as rapidly as possible. This sequence is 1) recognition of early warning signs, 2) activation of the emergency medical system, 3) basic cardiopulmonary resuscita- tion, 4) defibrillation, 5) intubation, and 6) intrave- nous administration of medications. The descriptive device "chain of survival" communicates this under- standing in a useful way (Figure While separate specialized programs are necessary to develop strength in each link, all of the links must be con- nected. Weakness in any link lessens the chance of survival and condemns the efforts of an emergency medical services (EMS) system to poor results. The chain of survival concept has evolved through several decades of research into sudden cardiac arrest. Effective system interventions have been identified that will allow survivors to remain neurologically intact. While a few urban systems may have ap- proached the current practical limit for survivability from sudden cardiac arrest, most EMS systems, both "Improving Survival From Sudden Cardiac Arrest: The 'Chain of Survival' Concept" was approved by the American Heart Association SAC/Steering Committee on October 17, 1990.