Mark Whelchel, DNP, ACNP-BC, director of Healthcare and Prehospital Education for the American Red Cross, spent six years working in emergency care at Baltimore Shock Trauma and cardiac ICU at the Penn State Heart and Vascular Institute. During this time, thanks to advances in response and care, hospitals saw more cardiac arrest patients survive to hospital discharge.
Yet when those in the profession examined this key success metric, they began to question whether it was the right benchmark.
“We may have saved their lives, but there is a long-term critical care need beyond the hospital because these patients’ hearts are severely damaged,” said Whelchel.
A cardiac arrest survivor often requires comprehensive, multidisciplinary support services to thrive. Being healthy means managing emotional and mental health needs for the patient and the family, who are thrust into the unexpected role of caregivers.
To better reflect these realities, the Red Cross has updated its cardiac arrest chains of survival to add a “recovery” step. Survival rates from cardiac arrest – whether in-hospital or out-of-hospital – are now simply one measure of success.
The chain of survival concept originated from the International Liaison Committee on Resuscitation in the early 2000’s. Originally it consisted of four steps, in this order: early access to emergency medical care, early CPR, early defibrillation and early advanced cardiac life support. The addition of a recovery step is the first change to the cardiac arrest chain of survival since integrated post-cardiac arrest hospital care was added in 2010.
Whelchel points to strides made by hospitals in recent years that enable patients to be discharged as close as possible, functionally and neurologically intact, to their pre-admission status. Building on the desire for a holistic approach to cardiac arrest, the sixth step of recovery aids in ensuring that progress continues after the hospital stay concludes.
For cardiac arrest, the recovery step begins as soon as the patient wakes up after the life-altering event. As part of the process, hospitals assemble teams that patients and their families meet with before discharge to discuss dietary, lifestyle and physical changes. The patient may see a dietician or get introduced to a therapist (physical, occupational and/or speech) and a family counselor. A survivorship plan is developed that identifies holistic health requirements and resources for that time when the patient is able to leave the hospital.
“The idea is to answer the question, ‘So he survived, but now what?’” summarized Whelchel. “The recovery link is illustrative of patient-focused multidisciplinary care.”
Learn more about the cardiac arrest chains of survival and how to help save a life by taking a Red Cross training course.