Testing the strength of the last link in the Chain of Survival

With more than 180.000 out-of-hospital cardiac arrests (OHCA) and 200.000 in-hospital cardiac arrests (IHCA) occurring annually in the United States and only 11% of OHCA and 26% of IHCA patients surviving to hospital discharge, much research in cardiac arrest has focused on improving early and acute interventions in the Chain of Survival, namely increasing early bystander interventions and reducing ambulance response times. Arguably, this has contributed to the promising increase seen in survival following cardiac arrest over the last decade. However, this increase in survival coupled with the general increase in cardiac arrest incidence will ultimately lead to more patients testing the strength of the last link in the chain: post-resuscitative rehabilitation. Survivors of cardiac arrest risk long-term consequences as a result of hypoxic-ischaemic brain injury, reduced health-related quality of life, emotional and physical problems and decreased societal participation. If the Chain of Survival fits within the notion that “a chain is only as strong as its weakest link”, we are facing a potential problem. Not necessarily because the last link is not strong, but because we know startingly little about it relative to the prior links due to a lack of evidence being done in rehabilitation after surviving a cardiac arrest. It is estimated that more than 70.000 patients in the United States are yearly discharged after cardiac arrest without a formal rehabilitation plan. The necessity for more evidence is clear. Bhagyalakshmi Nanjayya et al. provide a light in the dark of an evidence-sparce field.