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Chain of Survival

Chain of Survival
Pronunciation: chān of sər-ˈvī-vəl

The Chain of Survival refers to a series of actions that, when performed in sequence, increase the likelihood of survival and favorable neurological outcomes for someone experiencing a sudden cardiac arrest.

What is the Chain of Survival?

The Chain of Survival is a concept developed to maximize the effectiveness of both the general public and healthcare providers in recognizing and responding to sudden cardiac arrests. It involves distinct steps, each vital to ensuring the best chance of recovery.

Key Facts About the Chain of Survival:

  • It’s a series of time-sensitive steps.
  • Earlier interventions in the chain can significantly improve outcomes.
  • Both the layperson and professionals play roles in this chain.

Chain of Survival | Symptoms & Causes

What are the symptoms that necessitate the Chain of Survival?

The symptoms of sudden cardiac arrest include:

  • Sudden collapse or unconsciousness.
  • No pulse or heartbeat.
  • Absence of breathing or abnormal breathing patterns.
  • Possibly, prior chest pain or shortness of breath.

What triggers the need for the Chain of Survival?

The main causes are:

  • Ventricular fibrillation or ventricular tachycardia.
  • Myocardial infarction (heart attack).
  • Severe electrolyte imbalances.
  • Respiratory arrest leading to cardiac arrest.

Chain of Survival | Diagnosis & Treatments

What are the steps in the Chain of Survival?

For out-of-hospital cardiac arrest, the steps are:

  1. Early Recognition and Calling for Help: Recognizing cardiac arrest and immediately calling emergency services.
  2. Early CPR: Initiating cardiopulmonary resuscitation (CPR) to maintain blood flow to vital organs.
  3. Early Defibrillation: Use of automated external defibrillators (AEDs) to restore normal heart rhythm.
  4. Advanced Life Support: Administered by trained healthcare providers, including medications, airway management, and other interventions.
  5. Post-Cardiac Arrest Care: Comprehensive care in the hospital, including treatments to preserve brain function and minimize organ damage.

How is the Chain of Survival implemented?

The sequence is activated by:

  1. Bystanders recognizing symptoms and initiating CPR.
  2. Accessing and using an AED if available.
  3. Emergency services arriving and providing advanced interventions.
  4. Transfer to a specialized hospital facility for continued care.


  1. American Heart Association. (2020). Chain of Survival. Retrieved from
  2. Emergency Cardiovascular Care Committee. (2018). Resuscitation science and the Chain of Survival in sudden cardiac arrest. Heart & Lung, 47(3), 223-228.
  3. National Resuscitation Council. (2019). Chain of Survival Guidelines. Retrieved from