The History of CPR

CPR, or cardiopulmonary resuscitation is the method of providing oxygenated blood to the brain and other vital organs as a means of basic life support until more advanced help is available.

Today, this is done through rescue breathing, usually mouth-to-mouth, and by performing manual chest compressions.

However, as you're about to find out, this wasn't always the way things were done. The following history of CPR describes the various methods used to bring a person back to life from death or near death, as in drowning, dating from the early ages to the present.


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Early Ages-The Heat Method

When an individual had died people realized that the body became cold and therefore connected warmth with life. Because of this methods of rewarming such as placing hot ashes, burning excrement, or hot water directly on the person were used in an effort to restore life.



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Early Ages-Flagellation Method

The victim was actually whipped in an attempt to resuscitate.



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1530-The Bellows Method

In the 1500's it was not uncommon to use a bellows from a fireplace to blow hot air and smoke into the victim's mouth, a method that was used for almost 300 years. As you can imagine, people didn't ordinarily carry fireplace bellows around with them and it became the motivation behind the design of Bag-Valve-Mask Resuscitators used for CPR today.

However, in those days, medical authorities weren't aware of the anatomy of the respiratory system and didn't appreciate the need to extend the victim's neck in order to obtain a clear airway.

In 1829, Leroy d'Etiolles demonstrated that over distension of the lungs by bellows could kill an animal, so this practice was discontinued.



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The 1700's

The Fumigation Method

Used by Native American Indians and later introduced to the the English colonists, this was a method by which tobacco smoke was blown into a bladder(tube), and then inserted into the rectum of the victim.

It's said to have been discontinued after Benjamin Brodie reported, in 1811, that through experiments on animals he had discovered that 4 ounces of tobacco would kill a dog and 1oz would kill a cat. In fact, Brodie wrote, in 1811, "a single drop [of emphyreumatic oil, a constituent of tobacco] injected into the rectum of a cat occasioned death in about five minutes; and double the quantity administered, in the same manner, to a dog was followed by the same result"

(Brodie,B. 1811. Lancet. quoted/cited by: Livemore,A A. Anti-Tobacco. (pub later by Robert Bros). 1882.)



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The Inversion Method

Used in the case of drowning victims by ancient Egyptians and South American Indians, and then later introduced to Europe, this involved the victim being hoisted up by tied ankles to raise and lower the head in an effort to expel water.

In response to the increasing numbers of drowning during this time period, societies were formed to organize efforts in resuscitation. England's Royal Humane Society was founded in 1774. Although it was the most famous, it was not the first. It was preceded by the Dutch Society for Recovery of Drowned Persons, established in 1767. The Dutch recommendations included:

1. Warming the victim (which sometimes required transporting the body to a different location) by lighting afire near the victim, burying him in warm sand, placing the body in a warm bath, or placing the victim in a bed with one or two volunteers; 2. Removing swallowed or aspirated water by positioning the victim head lower than his feet and applying manual pressure to the abdomen, vomiting was induced by tickling the back of the throat with a feather 3. Stimulation of the victim, especially the lungs, stomach and intestines by such means as rectal fumigation with tobacco smoke, or the use of strong odours 4. Restoring breathing with a bellows 5. Bloodletting.



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The Barrel Method

The victim was placed on top of a large barrel, such as used for wine, and rolled back and forth. This action caused compression of the chest cavity forcing air out and then in a release of pressure allowed for air drawn back in.



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The 1800's

The Russian Method

As a means to slow the body, this method employed that the victim be buried in snow and ice up to the head. It's of interesting significance that modern science has shown the sometimes positive effects of hypothermia for the preservation of vital organs. Unfortunately, those who used this early method didn't realize the most vital organ that needed to be addressed was the brain.



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Trotting Horse Method

During the 1800's lifeguards were given a horse which was tied at the lifeguard station. When a drowning victim was rescued, he was placed on top of the horse which then was run up and down the beach. The up and down bouncing motion of the horse provided a means of alternating pressure and relaxation to the chest of the victim.


Tongue Stretching

Recommended in the late 1800's by French authors, this method involved holding the victims mouth open while pulling on the tongue in a forceful and rhythmical manner.

1858-The Silvester Method of Ventilation

Henry Robert Silvester attended the King’s College in London. He became a member of the Royal College of Surgeons in 1853 and in 1855 obtained his medical doctorate at the University of London. In 1858, he described a method of artificial ventilation in which the patient lies on his or her back with arms raised to the sides of the head, held there temporarily, and then brought down and pressed against the chest. This movement was repeated 16 times per minute.

1911 - Holger Nielsen Technique

The Holger Nielsen technique, described in the first edition of the Boy Scout Handbook in the United States in 1911, described a form of artificial respiration where the person was laid on their front, with their head to the side, and a process of lifting their arms and pressing on their back was perfomed. It's basically the Silvester Method with the patient flipped over.



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The Rocking Method

In 1932 Dr. Frank C. Eve published in the Lancet the method consisting of laying the victim of respiratory arrest on a stretcher, which was pivoted about its middle on a trestle and rocking up and down rhythmically so that the weight of the organs pushed against the diaphragm alternately up and down. It was also supplemented with mouth-to mouth respiration. This technique of CPR was officially adopted and endorsed by the Royal Navy during the Second World War for resuscitation of the nearly drowned.

1957 - Mouth-to-Mouth Resuscitation

It was not until the middle of the 20th century that the wider medical community started to recognize and promote resuscitation following cardiac arrest. Peter Safar wrote the book ABC of resuscitation in 1957. Peter Safar (born April 12, 1924 in Vienna; died August 2, 2003 in Mount Lebanon, Pennsylvania) was an Austrian physician of Czech descent. He is credited with pioneering cardiopulmonary resuscitation. Together with James Elam, he rediscovered the airway, head tilt, chin lift (Step A) and the mouth-to-mouth breathing (Step B) components of CPR and influenced Norwegian doll maker Asmund Laerdal of Laerdal company to design and manufacture mannequins for CPR training called Resusci Anne®. Safar, who began to work on cardiopulmonary resuscitation (CPR) in 1956 demonstrated in a series of experiments on paralyzed human volunteers that rescuer exhaled air mouth-to-mouth breathing could maintain satisfactory oxygen levels in the non-breathing victim, and showed that even lay people could effectively perform mouth-to-mouth breathing to save lives. He combined the A (Airway) and the B (Breathing) of CPR with the C (chest compressions), and wrote the book ABC of Resuscitation in 1957, which established the basis for mass training of CPR. This A-B-C system for CPR training of the public was later adopted by the American Heart Association, which promulgated standards for CPR in [1973]. (See http://en.wikipedia.org/wiki/Peter_Safar)


1960's - Cardiac Massage

The next major step in resuscitation was closed chest massage which was introduced in the 1960's by Dr. Kouwenhoven, Dr. Jude and a young engineer Knickerbocker. The crucial aspect of this technique is that the patient receives oxygen which is transported to the brain by the development of a minimal blood circulation. On this basis many national and international guidelines to perform CPR came out. (It should be noted that it was Kouwenhoven's early studies that inspired Division of Anesthesiology researchers James Elam and Peter Safar, to perfect the emergency mouth-to-mouth method of lung ventilation, crucial for oxygenating the blood when the heart stops.)

1961 - Cardiopulmonary resuscitation

The combination of both methods (ventilation and chest massage), was described in 1961 by Safar as cardiopulmonary resuscitation. During the Vietnam War the US army introduced CPR to the people for the first time. In 1973 the American Red Cross and the American Heart Association (AHA) began a campaign to teach the American population this method.


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