The Singapore Family Physician

Back to issue Vol 39 No. 3 - Emergency Medicine


V Anantharaman
The Singapore Family Physician Vol 39 No 3 - Emergency Medicine
20 - 31
1 October 2013
The practice of resuscitation is guided by the principle of the Chain of Survival, which essentially has four links, viz. Early Access, Early CPR, Early Defibrillation and Early Advanced Life Support. Basic cardiac life support consists of the first two links in the Chain of Survival. Thirty chest compressions to 2 ventilations at the rate of 100 compressions a minute is the norm. Hands only CPR is only used when the rescuer is unable to perform mouth-to-mouth ventilation for some reason. Defibrillation, the third link in the chain of survival, is one of the key strategies in the management of cardiac arrest victims. The commonest initial rhythm 3 at the onset of cardiac arrest is coarse ventricular fibrillation (VF) and the most effective therapy to date for this malignant rhythm is electrical defibrillation of the heart. Advanced Cardiac Life Support (ACLS), the fourth link in the Chain of Survival, is very dependent on the optimal conduct of the earlier three links. Arrhythmia management continues to be the cornerstone of ACLS guidelines. The 2011 guidelines have introduced post-resuscitation interventions into ACLS (i.e. measures carried out after Return of Spontaneous Circulation or ROSC).