Page 679 - ACCCN's Critical Care Nursing

656 S P E C I A LT Y P R A C T I C E I N C R I T I C A L C A R E

probability of an unsuccessful outcome grows with the always been adequate when a cardiac arrest occurs in the
length of time taken to restore spontaneous circulation. hospital, from the point of view of early recognition,
timeliness or availability of equipment or staff. 24,25 The
CHAIN OF SURVIVAL traditional cardiac arrest team responded to the seriously
To optimise a person’s chance of survival, the ‘chain of ill, but the patient was often not salvageable by the time
27
survival’ strategy has been developed, that represents the cardiac arrest team arrived. Two-thirds of in-hospital
the sequence of four events that must occur as quickly as cardiac arrests are potentially avoidable, with up to 84%
possible: early recognition, early CPR, early defibrillation of all in-hospital cardiac arrests demonstrating evidence
and postresuscitation care (see Figure 24.1). These time- of deterioration in the 6 to 8 hours preceding the arrest. 29,30
sensitive, sequential actions must occur to optimise a Consequently, in recent years there has been a move to
cardiac arrest victim’s chances of survival. Communities implement rapid response teams (RRT) that facilitate the
with integrated links along this chain have demonstrated early recognition and rapid management of critically ill
higher survival rates after OHCA than those with deficien- patients, for example the medical emergency team (MET),
cies in these links. 2 the patient-at-risk team (PART) and physiological track
and trigger systems (TTS) such as the medical early-
EARLY RECOGNITION OF CARDIAC ARREST warning system (MEWS) 31-33 (see Chapter 3 for further
The chain of survival begins with early recognition of a discussion). These teams replace the traditional cardiac
medical emergency and the activation of the medical arrest team by responding to a calling criteria based pri-
calling system. 2,28 However, the chain of survival has not marily on abnormal vital signs (see Table 24.2).

Chain of survival

Post resuscitation care
Early recognition and call for help Early CPR
Early Defibrillation

- to restore quality of life

- to prevent cardiac arrest

- to restart the heart
- to buy time
FIGURE 24.1 Chain of survival (Courtesy Koninklijke Philips Electronics NV).

TABLE 24.2 Early calling criteria
Children
Area Adults 0–12 months 1–8 years
Airway Threatened Threatened Threatened
Breathing All respiratory arrests All respiratory arrests All respiratory arrests
Respiratory rate <5 RR <20 RR <15
Respiratory rate >27 32 RR >50 RR >35
Grunting respirations
Circulation All cardiac arrests All cardiac arrests All cardiac arrests
Pulse rates <40 Pulse rates <70 Pulse rates <50
Pulse rates >140 Pulse rates >180 Pulse rates >160
Systolic BP <90 Systolic BP <50 Systolic BP <60
Capillary return >5 seconds
Marked pallor
Neurology Sudden fall in the level of Floppy Floppy
consciousness (fall in the Glasgow Unresponsive Unresponsive
Coma Scale score of ≥2 points) Depressed conscious level Depressed conscious level
Repeated or prolonged seizures Prolonged seizures Prolonged seizures
Other Any patient you are seriously Any patient you are seriously Any patient you are seriously
worried about who does not fit worried about who does not fit worried about who does not fit
the above criteria the above criteria the above criteria