12 CHAIN OF SURVIVAL IN ACTION Survival after out-of-hospital cardiac arrest (OHCA) depends on a sequence of coordinated actions across the continuum of care. The adult OHCA Chain of Survival, as defined by the American Heart Association 2020 Guidelines and reaffirmed in subsequent focused updates, includes five interdependent links, with recovery increasingly recognized as an additional component of post-cardiac arrest care. CARES captures standardized data elements at each stage, enabling communities to evaluate performance across the Chain of Survival and identify opportunities for improvement. These guidelines emphasize that participation in CARES is a Level 1 recommendation, recognizing the critical role of registries in supporting system-level performance measurement, accountability, and data-driven quality improvement. 2025 CARES Registry Snapshot CPR 42.5% received bystander CPR EMS Response EMS had a median response time of 7.6 minutes Recognition Bystander identifies collapse and calls 911 AED 13.9% had a bystander-applied AED Hospital Care 25.3% of patients were admitted to the hospital 1. Early Recognition and Activation of Emergency Response Recognition of cardiac arrest and activation of 911 initiate the emergency response system. CARES captures dispatch status, witnessed status, and arrest location to contextualize system performance. 1. Early High-Quality CPR Bystander CPR maintains perfusion prior to EMS arrival. CARES records whether CPR was initiated prior to EMS arrival and whether dispatcher assistance was provided. 1. Rapid Defibrillation For shockable rhythms (ventricular fibrillation or pulseless ventricular tachycardia), early defibrillation is associated with improved survival. CARES tracks initial rhythm, AED application, and shock delivery. 1. Effective Advanced Life Support EMS interventions include airway management, medications, defibrillation, and ongoing resuscitation. CARES captures response intervals, treatments provided, and return of spontaneous circulation (ROSC). 1. Integrated Post–Cardiac Arrest Care Hospital-based care influences survival to discharge and neurological outcome. CARES links prehospital care with hospital disposition and neurologic status at discharge.
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