CPR is a major part of today’s society and an essential skill in any medical training, so it is difficult to imagine a time when people used to live without it. However, CPR did not start out as the chest compression technique we know today. Cardiopulmonary resuscitation has changed dramatically throughout the years as people, and medical professionals experimented with emergency medicine.
Nowadays, proper CPR can double or even triple a person’s chance of survival after their heart has stopped. This fact emphasizes the importance of CPR training for everyone as part of their education and the need to raise the public’s awareness about the importance of public health.
But, to really appreciate today’s achievements in resuscitation science, let us explore the timeline of CPR development throughout history.
The Evolution of CPR
The evolution of CPR can be traced back to the 16th century when the first attempts to restore breathing were made, through the 18th century with the first mouth-to-mouth resuscitation and the rise of the Society for Recovery of Drowned People, the first chest compressions in the 19th century, all the way to today’s CPR practices.
The early beginnings of CPR contained some questionable methods.
During the 1500s, people believed that inflicting pain on a patient’s body shocked their system into restoring function. This gave rise to the so-called Flagellation Method of resuscitation, which involved whipping the patient’s body or hitting it with hands or wet cloths.
Around the 1530s, fireside bellows were used as a means to force air into a patient’s chest. This method is believed to have been first used by the Swiss physician Paracelsus. Variations of this practice existed for three centuries until they were finally discontinued in the 1800s.
The 18th century was a time for new milestones in CPR.
In 1744 William Tossach documented the first attempt to perform mouth-to-mouth resuscitation on a suffocated coal miner in Alloa, Scotland. His idea was later supported by John Fothergill and other enthusiasts who believed this method showed real promise in restoring breathing after a patient stopped breathing on their own.
Society For Recovery of Drowned People
The popularity of the mouth-to-mouth resuscitation method gave rise to the first humane society founded in Amsterdam in 1767. Soon after, other similar organizations were created all over Europe in an attempt to decrease the number of untimely deaths caused by drowning.
In 1774 the Society for the Recovery of Persons Apparently Drowned was born in London under the initiative of Dr William Hawes and Dr.Thomas Cogan. However, later on, the society substituted its recommendation for performing mouth-to-mouth resuscitation for the use of bellows for artificial ventilation.
The Inversion Method
During the 18th century, other first aid and resuscitation methods were also popular, such as the inversion method. This method was popular in the US and Europe at the time and involved hanging or lifting a person upside down to expel any water out of the lungs.
The Barrel Method
Another similar technique is used in the barrel method, where the person who ceased breathing would be rolled over a large barrel. The back-and-forth movement of the barrel was believed to have aided in breath restoration by compressing and decompressing the lungs, similar to chest compressions, although they would not come into play for another half a century.
The 19th century marked slow but steady progress in the field of emergency medicine and cardiopulmonary resuscitation.
The Trotting Horse
Yet another unconventional method of breath restoration occurred that was briefly used for drowning patients, mainly in coastal areas where they would place the unresponsive body of the drowning victim on horseback. As the horse trotted around, it put pressure on the lungs, thus mimicking respiration.
The Hall and Silvester Method
The second half of the 19th century was a time for new discoveries. In 1856 Marshall Hall, a London physician, first discovered that the simple act of turning a patient on the side and adding pressure to the thorax improves their likelihood of survival.
Two years later, another London physician, Dr Henry Silvester, created the chest-pressure arm-lift method. His method involved lifting the patient’s arms above their heads to expand the chest and then crossing them over the chest to exert pressure.
First Chest Compressions
Another groundbreaking discovery that did not receive the recognition it deserved at the time came toward the end of the century when a German surgeon by the name of Friedrich Maass performed the first ever documented instances of chest compressions. He advocated for the idea that chest compressions should be used alongside ventilation but didn’t succeed in convincing the public at the time.
The 20th century was truly a time for emergency medicine and technology innovations. It saw the rise of the American Heart Association (AHA), the discovery and use of the defibrillator, and the beginning of CPR training.
The Beginnings of the AHA
In 1924 six American cardiologists established the American Heart Association in Chicago. A couple of decades later, in the ’60s, doctors Kouwenhoven, Safar, and Jude, pioneers in their field, used mouth-to-mouth artificial ventilation and chest compressions to revive a patient. This was the beginning of the standard norm for CPR, which the AHA endorsed and introduced to the general public.
In 1974 the AHA published the first guidelines for advanced cardiovascular life-support (ACLS). Towards the end of the century, the association came up with national guidelines for CPR in infants and started providing telephone assistance and CPR instructions.
In 1957 a team of scientists at Johns Hopkins under the guidance of William Bennett Kouwenhoven invented the first portable A-C Closed Chest Defibralator after several years of research and attempts. The product was thoroughly tested on animals before it was first used on a human patient on March 17, 1957. The doctor who performed the defibrillation was a Hopkins Hospital resident named Gottlieb C. Friesinger II, and the patient was successfully revived.
In the 1960s, a life-size manikin was created to help the mass CPR training efforts and to make CPR certification readily available for as many people as possible. The manakin is widely popular as “Resusci Anne” and is responsible for hundreds if not thousands of saved lives throughout the world.
The twenty-first century is a time for perfecting cardiopulmonary resuscitation. After decades of medical research and countless instances of trial and error, scientists can now calculate the optimal rate, duration, and depth of chest compressions.
- In 2005 the American Heart Association came up with the Family & Friends CPR Anytime kit that allows users to learn CPR in a matter of minutes. The kit provides great help in instances of out-of-hospital cardiac arrest.
- In 2008 the association came out with a new recommendation stating that bystanders should use Hands-Only CPR and not provide mouth-to-mouth resuscitation until help arrives.
CPR as We Know It
Today, cardiopulmonary resuscitation performed in an out-of-hospital setting typically entails:
- Evaluating the surroundings and assuring the person who is about to receive CPR is unresponsive and, indeed, not breathing
- Calling 9-1-1 or calling out for help
- Obtaining a nearby AED, if available
- Ensuring the victim’s airway is unobstructed by tilting their head back
- Starting and continuing chest compressions at a rate of 100 to 120 compressions per minute until medical professionals arrive.
Conclusion – CPR in The Future
CPR has come a long way through the years, and if the past is any indicator, it will continue to improve in the future. Although general guidelines have remained consistent in the past decade or two, small advancements are being made every day.
Scientists are now creating manikins that give valuable feedback in terms of hand placement, depth and ratio of chest compressions, and ventilation to facilitate better training. There are even a number of mobile apps emerging on the market that provide support in administering cardiopulmonary resuscitation.