Chain of Survival AHA Resuscitation Guidelines 2010

Image link: http://circ.ahajournals.org/content/vol122/18_suppl_3/images/large/zhc1431087430001.jpeg (AHA Website)

To increase the chance of successful resuscitation following cardiac arrest, this requires an integrated set of coordinated, sequential actions represented by a chain of links. This is known as the Chain of Survival.

The links include the following:

• Immediate recognition of cardiac arrest and activation of the emergency response system (in Malaysia it is 999)
• Early CPR with an emphasis on chest compressions
• Rapid defibrillation (using Automated External Defibrillator [AED] in the case of cardiac arrest in public places)
• Effective advanced life support
• Integrated post–cardiac arrest care (this is a new addition chain as compared to the four-chain concept in 2005 guidelines; thus recognizing the importance of ICU post-cardiac arrest including therapeutic hypothemia in selected cases)

Note that out of the five chains, three chains can be performed by the public; and in fact, most of the time, would probably be carried out by the public as they are the ones who will most likely witness the cardiac arrest on the spot. The medical professionals cannot be in every place every moment. If the public does not perform the first three chains properly, by the time the victim reaches hospital, even in the setting of best advanced life support care, and even if the emergency team successful resuscitate the victim, the quality of life the victim would probably be affected as he/she might have suffered brain damage due to lack of oxygen.

This goes to show how vital public or community education and participation is to increase the chance of survival of a cardiac arrest.