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New CPR Guidelines Address Recovery Needs of Cardiac Arrest Survivors

AHA chain of survival

 American Heart Association

Key Takeaways

  • Individuals who survive cardiac arrest and their caregivers need continued support during and after their recovery.
  • The American Heart Association recommends adding a new link to the CPR “Chain of Survival” that addresses cardiac arrest survivors’ ongoing needs.
  • Spreading awareness of the new guidelines among healthcare providers and the public is key to implementing change.

The American Heart Association (AHA) published new CPR guidelines in the October 20 issue of Circulation. The authors recommend adding a sixth link to the CPR “Chain of Survival,” a series of critical actions aimed at improving the odds of someone surviving cardiac arrest, especially when it happens outside of the hospital.

The Chain of Survival currently has five points of action, and this new step would explicitly address cardiac arrest survivors’ ongoing physical, social, and emotional needs.

Original 5 Chain of Survival Links
  • Recognition of cardiac arrest and activation of the emergency response system

  • Early cardiopulmonary resuscitation (CPR) with an emphasis on chest compressions

  • Rapid defibrillation

  • Basic and advanced emergency medical services

  • Advanced life support and post-cardiac arrest care

Updated 6 Chain of Survival Links
  • Recognition of cardiac arrest and activation of the emergency response system

  • Early cardiopulmonary resuscitation (CPR) with an emphasis on chest compressions

  • Rapid defibrillation

  • Basic and advanced emergency medical services

  • Advanced life support and post-cardiac arrest care

  • Long-term recovery support for physical, cognitive, and psychosocial needs

According to the AHA, emergency medical services personnel treated approximately 350,000 adults in the United States with non-trauma related cardiac arrest outside of the hospital setting during 2015. Of those patients, 10.4% survived their initial hospitalization, and 8.2% survived with good functional status.

The authors define good functional status as a score of 1 or 2 on the Cerebral Performance Category Scale.

Ashish Panchal, MD, a board-certified emergency medicine physician with Ohio State University and guideline author, tells Verywell Health that previous data showed a lack of attention to post-cardiac arrest care.

“We already know that there is variability throughout the U.S. when it comes to survival," Panchal tells Verywell. "A lot of that is due to the strengths of the chain of survival. The new recommendations outline a specialized approach to making sure patients attain the best possible outcome. We want to optimize planning to make sure that they get all the support that they need.”

Panchal says that the aftermath of cardiac arrest can include anxiety, depression, post-traumatic stress, cognitive and neurological damage, physical deterioration, and cardiopulmonary impairment.

“Patients are going to have completely different reactions [to cardiac arrest]. No one patient is going to have the same recovery period," he says. "Patients should have a comprehensive rehabilitation plan that integrates all of their different needs. The roadmap to recovery is a process, and each step may have different outcomes. You need specific strategies for each of these periods.”

What Is Cardiac Arrest?

According to the AHA, cardiac arrest is the abrupt loss of heart function. It's caused by a malfunction in the heart’s electrical system. Cardiac arrest is not the same as a heart attack. However, a heart attack, which is caused by a blockage preventing blood flow to the heart, can cause cardiac arrest.

Addressing the Mental and Emotional Consequences of Cardiac Arrest


Sabrina Romanoff, PsyD
, is a clinical psychologist and post-doctoral fellow at Lenox Hill Hospital in New York who specializes in the impact of stress on the bodies of individuals experiencing cardiovascular conditions. She tells Verywell that many of the patients she works with experience high levels of depression, anxiety, and post-traumatic stress, which increase their risk of further cardiac problems.

“Many of these patients experience severe emotional reactions, and the impact of these reactions depends on how they manage these emotions,” she says. “The rehabilitation process involves managing the acute stressors, like fears of dying and concerns about future health.

A patient’s response to their emotional distress can either help or hinder their recovery, Romanoff explains.

“If the experience of cardiac arrest motivates the individual to change lifestyle habits to reduce the risk of another cardiac event, the person may feel safer and reassured about the future," she says. "But if anxiety paralyzes the person, they may continue harmful behaviors because those are familiar, easy, and comforting.”

Many survivors find they have a different outlook on life after a cardiac arrest.

“Once survivors can overcome their fears, they will often approach their lives with a new perspective. This requires a significant psychological adjustment because life as it once was will not be the same for them,” Romanoff says.

Support for Caregivers Is Important, Too

Romanoff says that the stress and anxiety of a cardiac arrest can also affect the caregivers of survivors.

“Some may employ avoidant strategies to cope with the threat of loss or danger. This may include secrecy about the event, not telling others about it because of feelings of distress when discussing it, and a desire to resume life as if it did not happen,” she says.

What This Means For You

If you or a loved one has experienced cardiac arrest, these new proposed guidelines should help get you the longer-term physical and emotional help you need for a successful recovery.

How Do Healthcare Providers Implement Changes?

Panchal says hospitals and bedside clinicians need to start thinking about survivors’ long-term needs while they are still in the hospital.

“Hospitals need to start forming survivorship plans before the patient goes home,” he says. “Hospital providers are going to have to be advocates for the best care.”

Community resources and education are also vital to the implementation of the new guidelines.

“You have to have local advocates that are pushing that this is the best for survival. We have advocates around the country. The guidelines set the framework, but within the local structure, that’s going to be the driver,” Panchal says. “The AHA is making this a priority, and that itself becomes a strong driver for patient outcomes.”

Where Can You Find Support?

The Sudden Cardiac Arrest Association promotes AED use in the community and offers support to cardiac arrest survivors. Cardiac arrest survivors can speak with fellow survivors by calling 1-855-COPE-SCA (1-855-267-3722).

“The recommendations that we put out are based on the best science and the best goal of improving patient outcomes,” Panchal says. “We can start changing the story from ‘people die from cardiac arrest’ to ‘people survive cardiac arrest.’”

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  1. Panchal AR, Bartos JA, Cabanas JG, Donnino MW, et al. 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020:142(Issue 16_suppl_2): S1. doi:10.1161/CIR.0000000000000929

  2. Panchal AR, Bartos JA, Cabanas JG, Donnino MW, et al. Part 3: adult basic and advanced life support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020;142:S366–S468) doi:10.1161/CIR.0000000000000916

  3. American Heart Association. About cardiac arrest. Updated March 31, 2017