The Chain of Survival

Rescue workers provide care for an unconscious person in an ambulance using ventilators and resuscitation equipment.

The Chain of Survival describes a series of steps that significantly increase a patient’s chances of survival in the event of cardiac arrest or a myocardial infarction (heart attack).

According to the German Heart Report (Herzbericht) 2024, cardiovascular diseases account for almost half of the most common causes of death – a trend that is likely to become even more relevant with demographic developments and the aging of the population.¹

In this article, you will learn everything you need to know about the Chain of Survival, its huge importance, and modern ventilators that help optimize this lifesaving process.

What is the Chain of Survival?

The Chain of Survival describes the prehospital actions that are taken in the event of sudden cardiac arrest or a heart attack. The aim is to ensure the survival of those affected through rapid and structured procedures.

The Chain of Survival is based on a concept that was first published by the American Heart Association (AHA)² in 1991. One of the main focuses was on establishing defibrillation as a crucial element of the Chain. Automated external defibrillators (AEDs) and their use by trained lay people play a central role in this.

The concept has been continuously developed and now forms the basis of international resuscitation guidelines implemented by organizations such as the AHA, the European Resuscitation Council (ERC)³ and the German Resuscitation Council (GRC)⁴. The guidelines are based on the recommendations of the International Liaison Committee on Resuscitation (ILCOR)⁵ and emphasize the importance of carrying out all the steps in the Chain of Survival quickly and precisely.

Importance of the Chain of Survival in cardiopulmonary resuscitation

In 2022, the German Heart Report found that coronary heart disease (CHD) remained the most common cause of death. Cardiovascular diseases as a whole, including acute myocardial infarction, heart failure, hypertensive heart disease and atrial fibrillation, account for around half of the ten most common causes of death.⁶

A crucial factor in the fight against sudden cardiac death is lay resuscitation, as rapid initial action by first aiders can save lives.

However, the rate of first aid in Germany still compares poorly with the rest of the world, standing at only around 45% in 2021. A study shows that despite regional progress, people’s willingness to provide resuscitation in the event of sudden cardiac death remains low. Time is a critical factor here: on average, 6.5 minutes pass between the alarm being raised and the arrival of the emergency medical services. Added to this is the often underestimated delay between the event and the emergency call being made.⁷

To make more effective use of these precious minutes and increase the chances of survival during resuscitation, it is therefore crucial to optimize the time sequences within the Chain of Survival.

Campaigns to improve the lay resuscitation rate in Germany are showing initial success, as the 2023 annual report of the German Resuscitation Register makes clear: At the reference locations, 50.7% of resuscitations were carried out by first aiders, with 33.0% of these interventions supported by guidance over the phone.

Despite this progress, the rate of lay resuscitation in Germany is still lagging behind leading countries such as Sweden and Norway in international comparisons.⁸

This is why the nationwide implementation of practical education on cardiopulmonary resuscitation is necessary in order to lower the inhibition threshold for lay people and increase the effectiveness of initial interventions.

Even simple, standardized training courses can increase the public’s confidence and ability to react appropriately in emergency situations, whether these involve a cardiac or circulatory arrest.

Sequence of the Chain of Survival

The Chain of Survival – whether in or out of hospital – consists of 6 steps that significantly increase a patient’s chances of survival in the event of cardiac arrest: Cardiopulmonary resuscitation (CPR), including targeted chest compressions, and the use of a defibrillator should be performed within the first 3 to 4 minutes, while further action must be initiated after 8 minutes at the latest.

Rapid action is crucial, as irreversible neurological damage can occur after just a few minutes without oxygen. Early interventions ensure blood flow to vital organs and significantly increase the likelihood of neurologically intact survival.

Out-of-hospital Chain of Survival

Ideally, lay people who are present at the time of the emergency should start taking lifesaving action immediately. The emergency control center can intervene by telephone to provide support until professional medical personnel can take over the next steps. Each link in the Chain of Survival makes a vital contribution to maximizing the chances of a patient’s survival after a cardiac arrest.

Call the local emergency number
Early CPR
Early defibrillation
Care by the emergency medical services
Follow-up care in the hospital
Rehabilitation

Rapid identification of a cardiac arrest is essential. Once identified, immediate action is required, in particular making an emergency call to call for professional help. Emergency control centers coordinate the operation and provide telephone instructions if necessary.

Immediate cardiopulmonary resuscitation by a first aider ensures blood circulation and oxygen supply to vital organs. The focus here is on chest compressions.

Defibrillation is performed using an automated external defibrillator to treat life-threatening cardiac arrhythmias. Advanced care begins when the emergency medical services arrive.

After successful resuscitation, intensive medical care stabilizes the patient and minimizes complications through continuous monitoring.

Rehabilitation forms the final link in the Chain of Survival and includes measures such as physiotherapy, psychological support and cardiological aftercare to restore quality of life.

Steps 1 to 3 are part of basic life support (BLS) by lay people, steps 4 and 5 are part of advanced life support (ALS) by professionals. The last step is part of the recovery phase. All links in the Chain of Survival are precisely coordinated to ensure an effective and lifesaving system.

In-hospital Chain of Survival

In hospitals, medical personnel have access to advanced technologies and specialized devices that enable precise treatment of patients in the event of cardiac arrest. Implementing the following steps in the Chain quickly and in a structured manner significantly improves their survival rate and chances of recovery:

Recognition
Activation of emergency response system
Early CPR
Early defibrillation
Follow-up care after resuscitation
Rehabilitation

Continuous monitoring of vital signs ensures that a cardiac arrest can be recognized immediately. Internal emergency management alerts the resuscitation team, which coordinates and promptly initiates the necessary action.

Medical personnel immediately begin CPR in order to maintain blood circulation until advanced measures are taken. Modern hospital defibrillators ensure that cardiac arrhythmias are treated quickly and precisely.

After successful resuscitation, intensive care devices are available to monitor the patient’s vital signs and prevent complications. During convalescence, physiotherapy and psychological support help the patient to recover physically and mentally in the post-acute phase.

Each of these steps must be carried out quickly and precisely in order to achieve the best possible outcome.

The Chain of Survival – lifesaving steps in an emergency

The Chain of Survival significantly improves a patient’s likelihood of survival in the event of cardiac arrest. Anyone who is confronted with an emergency of this kind – whether in a private, professional or medical environment – should be familiar with and able to apply the official guidelines so as to act effectively in an emergency.

Every link in the Chain of Survival must interlock seamlessly to ensure survival. In emergency situations, every minute counts – and every act can make a crucial difference. Innovative medical devices, such as the ventilators from WEINMANN, can make a vital contribution here.

Optimizing the Chain of Survival with WEINMANN ventilators

WEINMANN ventilators set new standards in resuscitation and systematically optimize the Chain of Survival with advanced functions.

The CCSV ventilation mode of MEDUMAT Standard² offers pressure-controlled ventilation that is synchronized with chest compressions. This ensures a maximum supply of oxygen to the blood and increases cardiac output during cardiopulmonary resuscitation – key factors that correlate directly with higher survival rates.

MEDUVENT Standard complements the portfolio with a precise and flexible approach to manual ventilation. The MEDUtrigger, which is attached directly to the ventilation mask, can be used to trigger breaths effortlessly and precisely, even under demanding conditions such as during resuscitation or anesthesia induction. The two-handed C-grip ensures an optimal seal for the mask, minimizes leaks and significantly improves ventilation quality.

With a combination of these functions, WEINMANN ventilators are indispensable aids in emergency medicine. The ability to switch flexibly between continuous and manual ventilation ensures seamless integration into any resuscitation procedure.