Cardiovascular Critical Care II

Foundation of advanced cardiac life support (ACLS) is effective and timely basic life support (BLS).

SCA can vary in etiology (noncardiac vs. cardiac), circumstances (unwitnessed vs. witnessed), and

setting (in vs. out of hospital).

Because of heterogeneity, action links that are denoted the “chain of survival” were developed for

guidance (Circulation 2016;133:447-54). There is an increased recognition in the differences between

arrests that occur in the hospital and those that do not, which has led to two distinct chains of survival:

In-hospital cardiac arrest (IHCA) chain of survival

Appropriate surveillance and early warning systems (prevention)

ii.

Activation of multidisciplinary response team

iii.

Early CPR that emphasizes chest compressions

iv.

Rapid defibrillation, if indicated

Advanced life support and post-cardiac arrest care

vi.

Recovery

Out-of-hospital cardiac (OHCA) arrest chain of survival

Immediate recognition of SCA and activation of emergency response system

ii.

Early CPR that emphasizes chest compressions

iii.

Rapid defibrillation, if indicated

iv.

Basic and advanced emergency medical services

Advanced life support and post-cardiac arrest care

vi.

Recovery

Following the chain of survival effectively can improve survival (e.g., with out-of-hospital, witnessed

VF arrest, survival rates can approach 50%) (Circulation 2006;114:2760-5). Because BLS and ACLS

are often experienced as a team approach in the hospital setting, it is imperative that hospital providers

be familiar with all aspects of BLS and ACLS in order to fulfill any role during the arrest situation.

Immediate recognition of SCA and activation of emergency response system (IHCA and OHCA - chain of

survival): Unresponsive patient or witnessed sudden collapse with absent or gasping abnormal breathing

Ensure that the scene is safe.

Check for response by tapping on shoulder and shouting at patient; simultaneously check for normal

breathing.

Activate emergency response system (e.g., calling 911), and follow instructions from trained

the activation of the emergency response team.

of survival).

C - Chest compressions are an essential component of CPR.

Not often provided by nonmedical individuals until professional emergency responders arrive

ii.

Both an increase in intrathoracic pressure and a direct compression of the heart lead to perfusion

and oxygen delivery to the brain and myocardium.

iii.

In OHCA not observed by emergency responders, immediate bystander chest compressions

improve survival over conventional CPR, stressing the importance of early chest compressions

on survival outcomes (Bobrow 2010).