The Chain of Survival for Cardiac & Stroke Emergencies
Something you likely noticed as you reviewed the first few chapters of your ACLS course’s textbook is that the chain of survival is the same as the one that you learned in your BLS class. You may also notice that the beginning steps of the Cardiac Emergency and Stroke chain of survival are the same. A review of the chain of survival and why it makes a difference is today’s Pass ACLS tip topic.
Chain of Survival
- Recognizing the symptoms of a cardiac emergency or stroke;
- Activating an emergency response by calling 9-1-1 or a specialized code team if in the healthcare setting;
- Rapid assessment including 12 lead ECG for cardiac patients or FAST assessment for suspected stroke emergencies;
- Providing ALS care and rapidly transporting to the most appropriate facility; for
- Early reperfusion.
Are the beginning links in the cardiac and stroke chain of survival.
Timed STEMI Goals
For ST elevation MI, a goal of 90 minutes from point of first medical contact to PCI has been established. The goal is 30 minutes or less from door to tPA administration in areas where PCI isn’t available.
Timed Stroke Goals
Our overall goal (clinically) is to deliver thrombolytic therapy, such as tPA, within 3 hours of the onset of stroke symptoms or 4.5 hours for patients that awaken with symptoms and have a confirmed last known well time. In cases of large vessel occlusion (LVO), our goal is to get the patient to a center capable of doing a thrombectomy (EVT) within 24 hours of the onset of symptoms.
EMS should transport patients with a suspected stroke to a certified stroke center that can meet these benchmarks:
- start a non-contrast CT within 20 minutes;
- have the CT read within 45 minutes; and
- tPA administration within within 60 minutes of the patient’s arrival. (door-to-needle)
NOTE: For cardiac patients, our timer to definitive treatment (PCI) starts from the point of first medical contact whereas for stroke, it’s arrival at the treating facility.
Hospitals that utilize Specialized teams generally have better outcomes because they’re are able to quickly assess patients using standardized criteria to recognize critical-needs patients early, then provide timely, well-coordinated, evidence-based care.
