THE CHAIN OF SURVIVAL

Presently we have a chain of survival that allows for teamwork action in cardiac arrest situations. Somewhere along the line, it also became known as The Chain of Survival for patients with acute myocardial infarction. Unfortunately, the Chain of Survival link for cardiac arrest and

acute myocardial infarction are not neatly superimposed. Cardiac arrests are perceived as emergency situations. This may apply to patients with acute myocardial infarction who crash with complications such as cardiogenic shock or acute pulmonary edema or even with crushing chest pain. It does not apply to the 50% of patients who present with milder forms of chest discomfort not perceived as pain and not perceived as emergency enough to go to the hospital.

To capture these patients it is important to recognize the importance of earlier recognition and response. Thus it becomes important to add a fifth link to the present Chain of Survival to strengthen it and allow it to be used for cardiac arrest situations and for patients with acute myocardial infarction. An alternative is to create a second chain of survival for acute MI, but that would confuse the issue even more. Promoting a fifth link in the present chain would also allow the medical community to emphasize intervention early as a form of acute prevention and help us to realize the potential of this strategy to reduce significantly heart attack deaths throughout the United States.

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