Optimization of the Prehospital Chain of Survival for Cardiac Arrest: Progress from High-Quality Cardiopulmonary Resuscitation to Early Defibrillation
Journal: Journal of Clinical Medicine Research DOI: 10.32629/jcmr.v7i1.5087
Abstract
Out-of-hospital cardiac arrest remains a major cause of sudden death, and survival largely depends on the effectiveness of the prehospital chain of survival. This review aims to summarize current progress in optimizing early recognition, bystander cardiopulmonary resuscitation, high-quality chest compressions, automated external defibrillator access, and coordinated emergency response. Evidence from recent guidelines, registry studies, systematic reviews, and implementation research was analyzed to identify key strategies that shorten treatment delay and improve early resuscitation quality. The results show that survival improvement depends not on a single intervention, but on the integration of rapid arrest recognition, dispatcher-assisted guidance, immediate CPR, timely defibrillation, public-access AED systems, trained citizen responders, digital dispatch tools, and emerging AED delivery models. In conclusion, optimizing the prehospital response system through coordinated, time-sensitive, and community-supported strategies is essential for improving outcomes after out-of-hospital cardiac arrest.
Keywords
out-of-hospital cardiac arrest, cardiopulmonary resuscitation, automated external defibrillator, early defibrillation, prehospital emergency care
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[3]Del Rios M, Bartos JA, Panchal AR, Atkins DL, Cabañas JG, Cao D, et al. Part 1: Executive Summary: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025;152(16 Suppl 2):S284-S312.
[4]Greif R, Bray JE, Djärv T, Drennan IR, Liley HG, Ng KC, et al. 2024 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Circulation. 2024.
[5]Semeraro F, Greif R, Böttiger BW, Burkart R, Cimpoesu D, Georgiou M, et al. European Resuscitation Council Guidelines 2021: Systems saving lives. Resuscitation. 2021;161:80-97.
[6]Bray JE, Gräsner JT, Finn J, et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: 2024 update of the Utstein out-of-hospital cardiac arrest registry template. Circulation. 2024;150(9):e203-e223.
[7]McBride O, Poel A, Counts CR, et al. Temporal patterns in out-of-hospital cardiac arrest incidence and outcome. JAMA Cardiol. 2025;10(9):922-931.
[8]El-Zein RS, Kennedy KF, Chan PS. Out-of-hospital cardiac arrest survival when CPR is initiated by first responders. Resuscitation. 2023;190:109914.
[9]Li S, Qin C, Zhang H, et al. Survival after out-of-hospital cardiac arrest before and after legislation for bystander CPR. JAMA Netw Open. 2024;7(4):e247909.
[10]Chen CY, Huang SK, Kang CW, et al. Effectiveness of dispatcher-assisted cardiopulmonary resuscitation in private home versus public locations for out-of-hospital cardiac arrest patients: A retrospective cohort study. Resuscitation. 2024;205:110421.
[11]Dainty KN, Debaty G, Waddick J, et al. Interventions to optimize dispatcher-assisted CPR instructions: A scoping review. Resusc Plus. 2024;19:100715.
[12]Grabmayr AJ, Dicker B, Dassanayake V, Bray J, Vaillancourt C, Dainty KN, et al. Optimising telecommunicator recognition of out-of-hospital cardiac arrest: A scoping review. Resusc Plus. 2024;20:100754.
[13]Gambolò L, Di Fronzo P, Ristagno G, Biserni S, Milazzo M, Socaci DM, et al. The role of different feedback devices in the survival of patients in cardiac arrest: Systematic review with meta-analysis. J Clin Med. 2024;13(19):5989.
[14]Snow L, Smith CM, Rees N, et al. Optimization of dispatcher instruction for public-access automated external defibrillator retrieval and use: A scoping review. Resusc Plus. 2025;25:101005.
[15]Scquizzato T, Belloni O, Semeraro F, Greif R, Metelmann C, Landoni G, et al. Dispatching citizens as first responders to out-of-hospital cardiac arrests: A systematic review and meta-analysis. Eur J Emerg Med. 2022;29(3):163-172.
[16]Andelius L, Hansen CM, Jonsson M, Gerds TA, Rajan S, Torp-Pedersen C, et al. Smartphone-activated volunteer responders and bystander defibrillation for out-of-hospital cardiac arrest in private homes and public locations. Eur Heart J Acute Cardiovasc Care. 2023;12(2):87-95.
[17]Kern M, Jansen G, Strickmann B, Kerner T. Advancements in public first responder programs for out-of-hospital cardiac arrest: An updated literature review. Rev Cardiovasc Med. 2025;26(1):26140.
[18]Schierbeck S, Nord A, Svensson L, Ringh M, Nordberg P, Hollenberg J, et al. Drone delivery of automated external defibrillators compared with ambulance arrival in real-life suspected out-of-hospital cardiac arrests: A prospective observational study in Sweden. Lancet Digit Health. 2023;5(12):e862-e871.
[19]Simmons KM, McIsaac SM, Ohle R. Impact of community-based interventions on out-of-hospital cardiac arrest outcomes: A systematic review and meta-analysis. Sci Rep. 2023;13(1):10231.
[20]Blomberg SN, Folke F, Ersbøll AK, et al. Effect of machine learning on dispatcher recognition of out-of-hospital cardiac arrest during calls to emergency medical services: A randomized clinical trial. JAMA Netw Open. 2021;4(1):e2032320.
[21]Starks MA, Chu J, Leung KHB, Chan TCY, Blewer AL, Simmons D, et al. Combinations of first responder and drone delivery to achieve 5-minute AED deployment in out-of-hospital cardiac arrest. JACC Adv. 2024;3(7):101033.
[22]Jakobsen LK, Kjærulf V, Bray J, Olasveengen TM, Folke F; International Liaison Committee on Resuscitation Basic Life Support Task Force. Drones delivering automated external defibrillators for out-of-hospital cardiac arrest: A scoping review. Resusc Plus. 2024;21:100841.
[23]Dezfulian C, Drennan IR, Merchant RM, et al. Part 4: Systems of Care: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025;152(16 Suppl 2):S353-S384.
Copyright © 2026 Guangrong Zhang, Doudou Jin, Siying Chen, Jinlong Zhou, Yansong Wang
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