The First Commandment of Resuscitation

The First and Great Commandment of Resuscitation -

Thou Shalt not have a Favourite Link in the "Chain of Survival"

 

It is called a chain because every link is critical. No one who truly understands how resuscitation works would lobby government for funding or policies to strengthen just one link in the chain. We need to build comprehensive community cardiac response programs that address and strengthen every link. I read an online debate from British Columbia this week arguing the merits of legislating mandatory CPR training versus mandatory AED placement. There is no question of "or" the only correct answer is "and".

In Ontario we have a physician group lobbying for mandatory CPR and I marvel at their naivety. In Manitoba they are hanging AED's all over the province with no mandatory training requirement, setting up a future filled with lost opportunities to save a life. The evidence is clear and unequivocal every link in the chain makes a significant contribution to improving survival rates for out-of-hospital cardiac arrest. Bystanders must quickly recognize the situation and spring into action, quality CPR must be started immediately, an AED must be applied soon after, EMS must get to the patients side quickly, ER physicians must cool the patient and the patient must take ownership of his/her rehabilitation. If you are engaged in advocacy to improve outcomes for cardiovascular emergencies in your community you must, must, must advocate for strengthening every link in the chain, not just your pet link.

Every cardiac arrest patient needs several things to go right if they are to survive neurologically intact to discharge. After reviewing tens of thousands of cardiac arrest data sets resuscitation researchers have proven beyond a shadow of a doubt that multiple inputs are required to achieve good outcomes.

We live in an evidence based world. Respect the evidence.