Chain of Survival

Thirty years ago, it was discovered that if a series of events took place, in a set sequence, a patient suffering from a heart attack stood a greater chance of survival. These events are now known as the 'Chain of Survival'.

When Sudden Cardiac Arrest strikes, an immediate 999 call is crucial; a delay of just a few minutes could prove fatal. By quickly recognising a medical emergency, a bystander can help save a life. Could you recognise the symptoms of Sudden Cardiac Arrest?

  • Unresponsiveness
  • Loss of consciousness
  • Lack of pulse
  • Cessation of breathing

Sudden Cardiac Arrest is not the same as a heart attack. However, a victim of either condition requires an immediate 999 call.

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CPR or Cardiopulmonary resuscitation is the second link in the Chain of Survival; it is the link that can buy life-saving time between the first link (Early Access to Emergency Care) and the third link (Early Defibrillation). During Sudden Cardiac Arrest, the heart twitches irregularly most often due to ventricular fibrillation (VF) and cannot pump oxygenated blood efficiently to the brain, lungs, and other organs. The victim quickly stops breathing and loses consciousness. However, prompt CPR can help sustain life during VF. The mouth-to-mouth breathing and chest compressions help oxygenated blood flow to the person's brain and heart, until defibrillation can attempt to restore normal heart pumping.

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Although it is an important link in the Chain of Survival, CPR alone cannot fully resuscitate a person in SCA. Early defibrillation is the third and perhaps most significant link. Most SCA victims are in ventricular fibrillation (VF), an electrical malfunction of the heart that causes the heart to twitch irregularly. Defibrillation, the delivery of an electrical shock to the heart muscle, can restore normal heart function if it occurs within minutes of SCA onset. When CPR and defibrillation are provided within eight minutes of an episode, a person's chance of survival increases to 20%. When these steps are provided within four minutes and a paramedic arrives within eight minutes, the likelihood of survival increases to over 40%.

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The fourth link in the Chain of Survival is advanced care. Paramedics and other highly trained EMS personnel provide this care, which can include basic life support, defibrillation, administration of cardiac drugs, and the insertion of endotracheal breathing tubes. This type of advanced care can help the heart in VF respond to defibrillation and maintain a normal rhythm after successful defibrillation. The trained EMS personnel monitor the patient closely on the way to the hospital, where more definitive diagnostic evaluation can occur.

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The effect of early intervention on patient survival is illustrated below:


 

Sarah Gibson

NW Regional Coordinator - chain of survival

To contact the team please email:

chain.surivival@nwas.nhs.uk

Celene Walmsley

Cheshire Area Coordinator

David Webster

Cumbria Area Coordinator

John Pennington

Lancashire Area Coordinator

Sarah Harris

Greater Manchester Area Coordinator

Sue Jenkins

Merseyside Area Coordinator