CPR – Cardio Pulmonary Resuscitation
Mouth-to-Mouth Ventilation
While CPR techniques are continuing to evolve, the idea of performing life-saving techniques has been around for many years. Initially, resuscitation efforts focused on saving drowning victims. The first reference to successful mouth-to-mouth ventilation was actually in the Old Testament. However, The Paris Academy of Sciences made the first official recommendation to use mouth-to-mouth resuscitation for drowning victims in 1740.
Dr. William Hawes and Dr. Thomas Cogan
In 1774, Dr. William Hawes and Dr. Thomas Cogan founded The Society for the Recovery of Drowned Persons in England. This was the first organized effort to provide first aid to drowning and also near-drowning victims. They offered training, as well as rescue equipment at locations, where drowning accidents were more likely to occur. These early methods provided respirations with a bellows as well as mouth-to-mouth. Other methods included abdominal pressure, warming the victim, and also placing the victim’s head below their feet. They also offered awards for rescuers who attempted to save drowning victims which included medals and cash awards. Now known as the Royal Humane Society, The Society for the Recovery of Drowned Persons is still active today.
External Cardiac Massage
Over 100 years after the introduction of mouth-to-mouth ventilation, Dr. Franz Koening developed the method of external cardiac massage. It applied pressure to the victim’s chest to stop cardiac arrest as well as restart the victim’s heart. In 1891, his student, Dr. Friedrich Maass performed chest compressions to successfully resuscitate a victim of cardiac arrest. The technique was developed to save people who were given too much chloroform during surgery. While the success was documented and published by Dr. Maass, some scientists doubted this claim. Others credit Dr. George Crile with being the first to successfully perform external cardiac massage in 1903. Dr. Crile was certainly the first American to perform external cardiac massage. In addition, he performed the first documented blood transfusion.
Defibrillation
In the 1930s, research was underway to study the effects of electricity on the human body. Research testing on dogs showed that an electrical shock could cause ventricular fibrillation. In addition, it showed that a second electrical shock may also stop the fibrillation and return the heart to a normal rhythm. Through his research, Dr. Claude Beck pioneered the use of providing an electrical shock to the heart to stop fibrillation. The goal was to reverse cardiac arrest in patients with otherwise healthy hearts. Dr. Beck worked with the Rand Corporation to build the first defibrillator.
In 1947, Dr. Beck performed the first successful defibrillation on a human patient, a 14-year-old boy went into cardiac arrest during surgery. The surgery went well and Dr. Beck was getting ready to close when the boy went into cardiac arrest. He reopened the patient’s chest and provided cardiac massage by hand for 45 approximately minutes. He then used the defibrillator to provide an electric shock directly to the heart. Although the first shock was unsuccessful, the second shock stopped ventricular fibrillation and the boy’s heart began to beat on his own.[1]
External Defibrillation
Dr. Paul Zoll
Dr. Paul Zoll was a cardiologist who pioneered external electric cardiac therapy. In 1952, Dr. Zoll was able to pace a heart in arrest by providing external electrical stimulation. In 1955, Dr. Zoll combined the external cardiac pacemaker with the defibrillator developed by Dr. Beck. to create the first external defibrillator. Later that same year, a 67-year-old man was the first patient successfully defibrillated by Dr. Zoll’s external defibrillator.
Portable Defibrillators
The defibrillators created by Dr. Beck and later by Dr. Zoll used alternating current. The major drawback to using alternating current is the size as well as the portability of the machine. In addition, the alternating current caused burns to the cardiac muscle. Dr.Bernard Lown solved those problems by developing a defibrillator that uses direct current. Dr. Lown performed extensive research to find the optimal voltage and waveform to stop cardiac fibrillation. He developed what is knows as the “Lown Waveform”. The method developed by Dr. Lown provided a direct current shock that consistently reversed ventricular fibrillation and did not damage the heart muscle.[2]
Dr. Frank Pantridge
Defibrillators became available in almost every hospital. They were used exclusively by doctors who were usually cardiologists. Having a defibrillator available in the hospital greatly increased the survivability of cardiac arrests that occurred in the hospital. However, patients who were suffering from cardiac arrest outside of the hospital had a high mortality rate. By this time it was understood that survivability would greatly increase if ventricular fibrillation could be treated before the patient arrived at the hospital.
In 1965, Dr. Frank Pantridge developed a portable defibrillator. His original unit, which weighed over 150 lbs (70kg), was installed in an ambulance in Belfast Ireland. In 1968 he developed a portable defibrillator that only weighed about 7 lbs (3kg). The program of providing defibrillation before the patient arrives in the hospital was a huge success. As a result, his idea of training ambulance technicians to use a defibrillator is now used around the world. It also led to the development of public access to defibrillators by lay rescuers.
Automated External Defibrillators
The AED or Automated External Defibrillator is an easy to use, portable, life-saving device. The AED will determine if the victim has a shockable rhythm. Users do not need to know how to read an EKG. Automatic AED’s only require the user to apply the pads and turn on the unit. It will automatically provide a shock if required. Semi-automatic AED’s will have a button for the user to provide a shock. If a shock is required, the AED will let the user know and prompt the user to administer the shock. The Semi-automatic AED will not allow a user to administer a shock if a shockable rhythm is not detected. Due to the latest technology, using an AED is extremely easy. You can learn how to use an AED quickly by taking an online class.
Rescue Breathing
Prior to 1954, the “chest pressure/arm-lift” technique was the accepted method of resuscitation. This was ineffective and did not supply oxygenated blood to the victim. But in 1954, the modern method of Rescue Breathing was introduced.
Dr. James Elam and Dr. Peter Safar
Dr. James Elam developed Modern Rescue Breathing. In 1954, Dr. James Elam and Dr. Peter Safar illustrated that expelled air had enough oxygen to sustain life. This was done when they anesthetized and curarized volunteers to temporarily paralyze them. The volunteers were given mouth-to-mouth ventilation by laypeople which also showed that anyone could perform the technique. As a result, The United States Military adopted Mouth-to-Mouth Rescue Breathing in 1957.
In 1958, The American Medical Association documented cases of Rescue Breathing saving lives. In addition, they made an official recommendation to provide Rescue Breathing as described by Dr. Elam and Dr. Safar.
In 1959, Dr. Elam published his findings in his book “Rescue Breathing”. In addition, some people credit Dr. Elam with inventing CPR. Together with a Norwegian toy company, he helped develop the “Annie” mannikin commonly used in CPR training classes.
Chest Compressions
Modern chest compressions force the heart to pump blood throughout the victim’s body. In 1958, professors at Johns Hopkins University accidentally discovered that compressing on the victim’s chest will circulate blood. William Bennett Kouwenhoven, Guy Knickerbocker, and James Jude were researching defibrillation. While experimenting on a dog, they discovered that pressing on the chest caused a pulse in the femoral artery. Further experiments with dogs helped determine the best location, depth, and rate of compressions.
In 1960, Kouwenhoven, Knickerbocker, and Jude published a report on 20 cases of in-hospital cardiac arrest.[3] Most of the patients suffered cardiac arrest as a result of anesthesia. Patients in cardiac arrest received chest compressions between 1 and 65 minutes. Of the 20 patients in the study, 14 survived and discharged from the hospital. The report stated that chest compression buys time until a defibrillator can be used. In addition, it also stated “Anyone, anywhere, can now initiate cardiac resuscitative procedures. All that is needed are two hands.”[4]
CPR – Chest Compressions and Ventilations Used Together
In 1960, Dr. Safar presented data which showed that chest compressions alone did not supply adequate oxygen to the patient. Mouth-to-mouth respiration also needed to be part of the resuscitation effort. Doctors Safar, Jude, and Kouwenhoven combined the methods of Chest Compressions with Rescue Breathing to create what we now know as CPR. They promoted CPR during an international speaking tour.
CPR Film – Pulse of Life
In 1962, David Adams and Dr. Archer Gordon produced a 27-minute film called Pulse of Life. This was the first motion picture to help teach CPR to the general public. This film also introduced the ABCs of CPR which stood for Airway-Breathing-Circulation. Pulse of Life was used to train people around the world.
Emergency Medical Services
The National Highway Safety and Traffic Act of 1966 established a national curriculum for first responders. This led to standardized training of EMTs or Emergency Medical Technicians. They received training in First-Aid and CPR, however, they lacked training for advanced cardiac or life-saving care. In 1968, Dr. William Grace, of St. Vincent’s Hospital in Greenwich Village in New York City, replicated the program developed by Dr. Pantridge. Therefore creating the first program in the United States to provide advanced cardiac care outside of a hospital. Dr. Grace’s program equipped ambulances with portable defibrillators. Physicians, nurses, and technicians staffed the ambulances and responded to calls. The program developed by Dr. Grace was extremely successful and consequently led many other cities to follow suit.
Dr Nagel
In an effort to reduce response time, Dr. Eugene Nagel of Miami began a program to train firemen to perform advanced cardiac care. However, his ideas received a great deal of resistance and skepticism. However, his program proved to be a better method of providing pre-hospital cardiac care.
In 1970, Dr. Leonard Cobb and Seattle Fire Chief, Gordon Vickery developed a new training program to treat cardiac arrest. The Seattle Fire Department already had a team of mobile first-aid units as well as the first computerized systems to document first-aid calls. Together, they developed a tiered response program to treat cardiac arrest. The mobile first-aid units were able to provide CPR until paramedics arrived and could provide advanced care. This care included defibrillation as well as the ability to administer drugs. He called this model Medic 1. Because of its success, many municipalities still follow the program.
CPR Training Classes
Since the development of CPR, doctors, medical professionals and first responders received instruction. As EMS systems progressed, an effort to reduce response times as well as provide life-saving care was underway. Dr. Leonard Cobb realized that the next step was to train non-professionals to perform CPR, therefore providing life-saving care more quickly.
In 1972, Dr. Cobb and Gordon Vickery offered mass training to everyday citizens in Seattle, Washington. The training program was called Medic 2. In the first few years, they were able to train over 100,000 people to perform CPR. This was the first ever mass CPR training. Classes were offered to the public and provided to high school students. Although there was a great deal of skepticism at first, documented cases of lay-rescuers saving lives provided proof that it works.
Modern CPR
In 1981, a program began to provide CPR instruction over the phone. In King County, Washington, 911 operators were trained to instruct callers to perform CPR while they were waiting for EMS to arrive. As a result, untrained lay-rescuers provided life-saving care. This program is now standard throughout the United States.
In 2008, the American Heart Association released a statement that providing Compression-Only CPR is also effective in saving lives. This determination is due to the fact that a victim who suffers cardiac arrest due to a heart issue, generally has about 4-5 minutes of oxygen in their system. By pushing “Hard and Fast”, the oxygenated blood will be circulated through their system as well as major organs. Therefore buying time before biological death sets in.
Kouwenhoven WB, Jude JR, Knickerbocker GG (1960). Closed-chest cardiac massage. JAMA. 173: 1064–67. doi:10.1001/jama.1960.03020280004002. PMC 1575823.
Zoll PM. Resuscitation of the heart in ventricular standstill by external electrical stimulation. N Engl J Med 1952; 249: 768-71
Kouwenhoven WB, Jude JR, Knickerbocker GG. CLOSED-CHEST CARDIAC MASSAGE. JAMA.1960;173(10):1064–1067. doi:10.1001/jama.1960.03020280004002
Defibrillator by Claude Beck and James Rand”. Archived from the original on 2006-10-04. Retrieved 2006-11-23.