The New Link in the Chain of Survival – Recovery

Recognizing the journey after sudden cardiac arrest

Until 2020, the American Heart Association’s Chain of Survival, which offers the optimal series of actions to be taken in the event of out-of-hospital adult sudden cardiac arrest, had five links. They were:

  1. Call 911 to activate emergency services
  2. Begin CPR
  3. Early Defibrillation with an AED
  4. Advanced Resuscitation by EMS upon their arrival
  5. Post cardiac care in hospital

These links have not changed; however, a sixth link has been added – Recovery. The AHA explains the reason for this addition:

Cardiac arrest survivors, like many survivors of critical illness, often experience a spectrum of physical, neurological, cognitive, emotional, or social issues, some of which may not become apparent until after hospital discharge. Survivorship after cardiac arrest is the journey through rehabilitation and recovery and highlights the far-reaching impact on patients, families, healthcare partners, and communities.


Rescuers Need To Recover As Well

It’s indisputable that supervised recovery is necessary for the patient as they deal with the many complications that can arise from a cardiac arrest, but self-care for the rescuer is often needed as well. Bystander rescuers are many times family members or acquaintances of the patient. So while their friend or family member is coping with the challenges of physical recovery, the rescuer may need to seek help coping with the event itself. 


Finding Closure

It’s important to remember that most people who are involved in performing out-of-hospital bystander CPR find themselves in a situation they have never been in before. The adrenaline rush quickly resolves into exhaustion upon the patient being transported to the hospital, which can then sometimes lead to difficult emotional strain. They may question themselves. Did I do it correctly? Could I have done more? Is the patient going to be ok? What if..(fill in the blank)?  The most important thing to remember is that doing something is always better than doing nothing when it comes to sudden cardiac arrest. Stepping in to do CPR, or get the AED, or anything, really, should always be a cause for a personal pat on the back. 

If a rescuer is having nightmares or is unable to sleep because they keep replaying the scenario over and over again; or if there are feelings of depression or self-harm, it’s important to seek help. They should:

  • Talk it out – either with a friend or professional mental health provider
  • Know that they did everything they could
  • Discover the outcome of the rescue so there is closure


The Odds

Only roughly 10% of people who go into sudden cardiac arrest outside of a hospital survive. In patients who receive immediate bystander response, that goes up to only 30%.  While this is a significant increase in the rate of survival, the truth is not everyone is going to survive. Anyone who is willing to go to the mat for another person in sudden cardiac arrest deserves a full recovery as well as the patient. 


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