Chain of Survival


  • The “chain of survival” is a conceptualisation of the interventions that contribute to a successful outcome after a cardiac arrest
  • like any chain, it is only as strong as the weakest link
  • the ultimate goal is not ROSC (return of spontaneous circulation) but to get the patient home with adequate health to enjoy a meaningful life


  • Early recognition and call for help –> to prevent cardiac arrest
  • Early CPR –> to buy time
  • Early defibrillation –> to restart the heart
  • Post resuscitation care –> to restore quality of life
Chain of survival
From the European Resuscitation Council (see reference below; click image for source).


  • There are versions of the chain of survival that include 6 or more components, e.g.
    1. Early recognition of cardiac arrest
    2. Early access to emergency medical care
    3. Early CPR
    4. Early defibrillation
    5. Early ALS
    6. Recovery (psychological and physical)
  • With the first three links in the chain being able to be performed by lay bystanders, the second three are designated to medical practitioners
Image from the American Heart Association (click image for source).

  • Wyllie, J., Bruinenberg, J., Roehr, C., Rüdiger, M., Trevisanuto, D., & Urlesberger, B. (2015). European Resuscitation Council Guidelines for Resuscitation 2015. Resuscitation95, 249-263. doi: 10.1016/j.resuscitation.2015.07.029 [Free full text]


CCC 700 6

Critical Care


Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of three amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

ICU Advanced Trainee BMedSci [UoN], BMed [UoN], MMed(CritCare) [USyd] from a broadacre farm who found himself in a quaternary metropolitan ICU. Always trying to make medical education more interesting and appropriately targeted; pre-hospital and retrieval curious; passionate about equitable access to healthcare; looking forward to a future life in regional Australia. Student of LITFL.

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