Cardiac arrest, chain of survival and Utstein style

Eur J Anaesthesiol. 2002 Sep;19(9):624-33. doi: 10.1017/s0265021502001035.


Cardiac arrest is a dramatic condition leading to sudden death if someone cannot perform two interventions, basic life support and early defibrillation, that have been proved to improve long-term survival. The modern era of cardiopulmonary resuscitation began with a description of closed chest cardiac massage by Kouwenhoven in 1960. Research to make advances in cardiac arrest is a very difficult task. Experts set up a series of guidelines that represent a keystone for educational needs and evolving technology. There is a consensus that the highest potential survival rate from cardiac arrest can only be achieved when the following sequence of events occurs as rapidly as possible: (1) recognition of early warning signs, (2) activation of the emergency medical services, (3) basic cardiopulmonary resuscitation, (4) cardiac defibrillation, (5) management of the airway and ventilation of the lungs, and (6) intravenous (i.v.) administration of medications. These events are necessary for any success of emergency cardiovascular care. They are linked in a chain of survival. The links in the adult chain of survival are: early access; early CPR; early defibrillation; and early acute cardiac life support. The 'Utstein style', recently introduced, represents a standard of practice both inside and outside hospital with recommended guidelines for the uniform reporting of clinical data from the patient suffering cardiac arrest. According to the concept of the chain of survival, the Utstein style delineates time and establishes a set of core and supplemental times to be recorded that provide important characteristics of the response of victims of cardiac arrest.

Publication types

  • Review

MeSH terms

  • Algorithms
  • Cardiopulmonary Resuscitation / methods*
  • Cardiopulmonary Resuscitation / standards
  • Death, Sudden, Cardiac / etiology
  • Electric Countershock*
  • Glasgow Coma Scale
  • Heart Arrest / mortality
  • Heart Arrest / therapy*
  • Humans
  • Practice Guidelines as Topic
  • Risk Factors
  • Survival