How do chain of survival guidelines for in-hospital cardiac arrests (IHCAs) vary from out-of-hospital cardiac arrests (OHCAs)?

Updated: Sep 15, 2020
  • Author: Catharine A Bon, MD; Chief Editor: Kirsten A Bechtel, MD  more...
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Answer

Answer

The 2015 update differentiates in-hospital cardiac arrests (IHCAs) from out-of-hospital cardiac arrests (OHCAs), with separate adult chain of survival recommendations that identify the different pathways for IHCA and OHCA, as outlined in Table 1, below. [45]

Table 1. Adult Chain of Survival (Open Table in a new window)

 

Link 1

Link 2

Link 3

Link 4

Link 5

IHCA

Surveillance and prevention

Recognition and activation of the emergency response system

Immediate high-quality CPR

Rapid defibrillation

Advanced life support and post-arrest care

Responder(s)

Primary Provider

Code Team

Cath Lab/ICU

OHCA

Recognition and activation of the emergency response system

Immediate high-quality CPR

Rapid defibrillation

Basic and advanced emergency medical services

Advanced life support and post-arrest care

Responder(s)

Lay Rescuers

 

Emergency Medical Services (EMS)

ED/Cath Lab/ICU

ILCOR and ERC do not separate in-hospital from out-of-hospital cardiac arrest in their definition of chain of survival, and, therefore, they do not have the IHCA’s link 1 of surveillance and prevention. Otherwise they have similar chains of survival. [46, 56]

Postresuscitation care recommendations were added to the 2015 update as a new section in collaboration with the European Society of Intensive Care Medicine. These postresuscitation care guidelines acknowledge the importance of high-quality postresuscitation care as a vital link in the chain of survival. [49]


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