System-specific Chains of Survival
This diagram shows the two system-specific chains of survival. It illustrates the differences in the steps needed for response to cardiac arrest depending on where the arrest occurs. Each chain includes five links, and below each link is a color-coded bar indicating who performs each step in the chain of survival. The top chain is labeled IHCA, which stands for “in-hospital cardiac arrest.” The first link contains a magnifying glass icon, which represents a system of appropriate surveillance and prevention of cardiac arrest. The second link has a telephone icon, indicating that when cardiac arrest occurs, there is prompt notification. This leads to the third link, which shows hands performing high-quality CPR. The bar below the chain indicates all three of these steps in the in-hospital cardiac arrest chain of survival are performed by primary providers. The fourth link in the chain contains an icon of a heart with an electric bolt symbol through it. This link represents prompt defibrillation, when appropriate. The bar below this link reveals the Code Team administers this step. The final link in the IHCA chain of survival contains an icon of a hospital bed with a monitor and thermometer. It represents post-cardiac arrest care, including advanced monitoring and targeted temperature management. The bar below shows the Intensive Care Unit, or ICU, performs this step. The bottom chain is labeled OHCA, which stands for “out of hospital cardiac arrest.” Its first link has a telephone icon to indicate prompt notification of medical personnel when cardiac arrest occurs. The bar below shows that lay rescuers are responsible for this step. The second link shows hands performing CPR. The third link (an icon of a heart with an electric bolt symbol through it) represents early defibrillation. The bar below the chain indicates these two steps in the out of hospital chain of survival are performed by lay rescuers or EMS. The fourth link contains an ambulance icon, representing transport of the patient to an Emergency Department or cardiac catheterization lab. The bar below shows this is the responsibility of EMS. Like the IHCA chain of survival, the last link for the OHCA chain contains an icon of a hospital bed with a monitor and thermometer. It represents post-cardiac arrest care. As the bar indicates, the ICU is responsible for this step. This figure is copyright 2015 by the American Heart Association.