The chain of survival refers to a series of actions that, properly executed, reduce the mortality associated with sudden cardiac arrest.
[4] According to the American Heart Association, out-of-hospital cardiac arrest can affect more than 300,000 people in the United States each year.
[3] Over the years, the American Heart Association has added two new links to the chain: post-resuscitation care in 2010,[7][3] and physical and emotional recovery in 2020.
[8] Mary M. Newman, co-founder and president/CEO of the Sudden Cardiac Arrest (SCA) Foundation and previous executive director of the National Center for Early Defibrillation at the University of Pittsburgh,[9] developed the chain of survival metaphor and first described it [6] in an article she wrote for the Journal of Emergency Medical Services in 1989,[10] and further promoted in an editorial she wrote for the first issue of Currents in Emergency Cardiac Care in 1990.
[16] While CPR keeps blood flowing artificially,[17] rapid defibrillation is the only way to restart the heart and reset it to a healthy rhythm.
[21][6] Public access defibrillation may be the key to improving survival rates in out-of-hospital cardiac arrest,[1] but is of the greatest value when the other links in the chain do not fail.
[15] ACLS ambulance providers use the mnemonic "MONA" (morphine, oxygen, nitroglycerin, and aspirin) to reflect the out-of-hospital therapies they will use for cardiac arrest.
[15] In October 2020, the American Heart Association added the recovery phase as the sixth link in the chain of survival.
Before being discharged from the hospital, the American Heart Association recommends that cardiac arrest survivors receive rehabilitation assessment and treatment for physical, neurologic, cardiopulmonary, and cognitive impairments.