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What is the Pediatric Chain of Survival?

By Justin Haagen on Jun 24, 2023

Ped chain of survival

Cardiac arrest in children: Secondary vs. sudden cardiac arrest

Sudden cardiac arrest occurs when the normal electrical impulses in the heart cause it to beat too quickly, inefficiently, or in an unsynchronized manner. It’s caused by a problem with the heart itself.

But pediatric cardiac arrest is rare considering most children have healthy hearts. When it does happen, it’s most commonly a result of asphyxia, which is a lack of oxygen that occurs when breathing slows or stops. This lack of oxygen causes the heart to stop within minutes.

Because the heart stops secondary to a lack of oxygen, it’s referred to as secondary cardiac arrest.

What causes secondary cardiac arrest in children? Common causes include:

  • Airway obstruction
  • Lung infections or diseases
  • Drowning
  • Choking

Additionally, children may experience secondary cardiac arrest from shock resulting from car accident injuries, burns, falls and child abuse.

Importance of rescue breaths for children and infants

Rescue breaths are extremely important for children and infants because cardiac arrest typically occurs from asphyxia. Therefore, getting oxygen into the body is critical. Rescue breathing helps stimulate the heart to beat faster and stronger, pushing oxygenated blood to the brain and encouraging the breathing effort.

All trained CPR providers should use conventional CPR (meaning a combination of chest compressions and rescue breathing) if they’re willing and able. However, untrained bystanders can still make a difference by performing compression-only CPR, also known as hands-only CPR.

Pediatric chain of survival in action

The pediatric chain of survival consists of six interdependent links that describe the best approach to cardiac arrest care for children and infants.



Just like with the adult chain of survival, the best chance of survival exists when all links are strong.

Bystanders play a crucial role in the first three links of the pediatric chain of survival:

  1. Prevention of cardiac arrest. Safety-focused strategies, such as using safety equipment, creating safe environments and actively supervising, can help prevent pediatric cardiac arrest.
  2. Prompt activation of emergency response. Calling 911 activates first responders in your area.
  3. Immediate high-quality CPR and early defibrillation. Early CPR provides oxygen to the heart, brain and other vital organs. Having access to an automated external defibrillator (AED) can deliver an electric shock to restore the heart’s normal contractions before emergency medical services arrive.

The final three links include advanced resuscitation, effective post-cardiac arrest care at a hospital and recovery. First responders and health professionals lead these efforts, including guiding family members on best practices for recovery support after hospital discharge.

Prevention is key to reducing pediatric cardiac arrest

The first link in the pediatric chain of survival, prevention, can significantly reduce the number of pediatric cardiac arrests from asphyxia. This includes preventing drowning and choking, as well as ensuring you’re using essential safety equipment and appropriate supervision.

For example, you can increase the safety measures around your backyard pool by installing pool fencing, pool alarms, door and gate alarms, and pools covers.

Other preventative measures include using child passenger safety seats correctly and encouraging your children to wear bicycle helmets when riding.

Get CPR, AED and First Aid certified

Each link in the pediatric chain of survival is essential for the most positive outcome. If a single link is missing, the chances of survival are greatly reduced.

As a lay rescuer, you can make a huge difference in the pediatric survival rate by practicing prevention strategies, calling 911 when you see someone in need and getting CPR, AED and First Aid certified.

Learn how you can get training and full certification with an CPR, AED and First Aid class.