The chain of survival refers to a series of actions that, properly executed, reduce the mortality associated with sudden cardiac arrest. Like any chain, the chain of survival is only as strong as its weakest link. The six interdependent links in the chain of survival are early recognition of sudden cardiac arrest and access to emergency medical care, early CPR, early defibrillation, early advanced cardiac life support, and physical and emotional recovery. The first three links in the chain can be performed by lay bystanders, while the second three links are designated to medical professionals. Currently, between 70 and 90% of cardiac arrest patients die before they reach the hospital. However, a cardiac arrest does not have to be lethal if bystanders can take the right steps immediately. Background According to the American Heart Association, out-of-hospital cardiac arrest can affect more than 300,000 people in the United States each year. Three minutes after the onset of cardiac arrest, a lack of blood flow starts to damage the brain, and 10 minutes after, the chances of survival are low. Therefore, bystanders have only a few minutes to act to optimize a person's chances of survival and recovery. To improve survival outcomes for people who have experienced out-of-hospital cardiac arrest, the American Heart Association–International Liaison Committee on Resuscitation recommended the chain of survival concept in the early 2000s. Originally, the chain consisted of four steps: early access to emergency medical care was the first link, the second link was early CPR, early defibrillation was the third link, and the final link was early advanced cardiac life support. Over the years, the American Heart Association has added two new links to the chain: post-resuscitation care in 2010, and physical and emotional recovery in 2020. Also in 2020, the American Heart Association issued a new pediatric chain of survival for infants, children, and adolescents. Mary M. Newman, co-founder and president/CEO of the Sudden Cardiac Arrest (SCA) Foundation and previous executive director of the National Center for Early Defibrillation at the University of Pittsburgh, developed the chain of survival metaphor and first described it in an article she wrote for the Journal of Emergency Medical Services in 1989, and further promoted in an editorial she wrote for the first issue of Currents in Emergency Cardiac Care in 1990. The American Heart Association later adopted the concept and elaborated on it in its 1992 guidelines for