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podcast transcript
For most of human history, it was thought that when a person’s heart stopped, that was the end.
Then, through centuries of trial and error, strange experiments, and medical breakthroughs, doctors discovered that death was not always instantaneous.
Stopped hearts can sometimes be restarted, and even ordinary people can learn how to save lives.
The result was one of the most important emergency procedures ever developed.
Learn more about the history and science of CPR in this episode of Everything Everywhere Daily.
Cardiopulmonary resuscitation (CPR) is one of those timeless medical techniques, but in its modern form it is surprisingly recent. For most of human history, acute cardiac arrest was considered final in nature.
People have tried many different methods to bring a seemingly dead person back to life, but they were often improvised, poorly understood, and often ineffective. Before we look at the history of CPR, we need to understand what CPR is.
Modern CPR is a life-saving procedure used when a person’s heart stops beating or breathing stops.
CPR includes chest compressions. These compressions involve pressing down to a depth of 2 inches on the center of the patient’s chest. Depending on the number of people present and the individual’s training, these compressions may be performed continuously or with 2 resuscitations per 30 compressions.
CPR may require breaking ribs and pounding chests, but it is an effective and immediate intervention that greatly increases the chances of survival.
CPR is important because it manually pumps the heart to keep blood flowing throughout the body. This helps prevent immediate damage to vital organs, such as the brain, because they are not cut off from their blood supply.
This practice is typically performed using two techniques: conventional CPR and chest compression CPR.
Conventional CPR is usually performed by people with formal training in CPR, such as medical professionals. This version sees the rescuer complete chest compressions and mouth-to-mouth breathing in a 30:2 ratio. This means 30 compressions for 2 breaths.
In CPR, adding rescue breaths is important to keep air in the patient’s lungs. This helps prevent oxygen desaturation, which can harm the body’s organs.
Chest compression CPR is typically used when members of the public witness a cardiac emergency. In this situation, only chest compressions are performed without breathing. Chest compressions are performed continuously during this method.
Compression-only CPR is recommended when rescuers witness someone collapsing outside a hospital and there may be potential health risks in performing mouth-to-mouth resuscitation without a barrier. We recommend completing your zip to the beat of “Staying Alive” by the Bee Gees.
The origins of CPR date back to ancient Egypt. Although the Egyptians did not perform CPR, it is an early example of artificial resuscitation. Historians have discovered written records of methods for reviving “apparently dead” people. One such method was to tap on a person’s heart and give them “the breath of life.”
Despite the Egyptian example, the first recorded case of CPR occurred in Persia in the 15th century. A doctor named Burhan-ud-din Kermani used a method of moving the arms to expand the abdomen and then compressing the chest.
Although some doctors were using Kermani’s resuscitation method, it was largely unpopular. This is unfortunate because the field of early childhood medicine would have advanced more quickly if CPR had been widely adopted earlier.
Instead, doctors often used the flagellum method. This involves the rescuer whipping the victim with objects such as stinging nettles, wet cloths, or their hands. The goal was to shock the victim into reacting.
Another common method of resuscitating victims around this time was to apply burning dried excrement, hot water, and embers to the body. The idea was that when a person passes by, the body becomes cold. Doctors hoped that by warming the body, they could raise body temperature and bring patients back to life.
In 1530, a Swiss physician named Paracelsus invented something called the Bellow Method. It was well known at this point that when a person dies, he or she stops breathing. Paracelsus decided to see if injecting air into the victim’s lungs would help in resuscitation.
For this, Paracelsus places a seal over the victim’s mouth, and a fireplace roars into the victim’s nostrils. This tool was typically used to force a controlled flow of oxygen into the fireplace during compression.
In this theory, the lungs were the fire and the bellows blew a controlled flow of air into the body. Unfortunately, this method had little effect because we were literally using the same tools we used on the fireplace. This means that it pushed ash and ashes into the victim’s lungs, causing more damage to them.
The next major development did not occur until 1667. British scientist Robert Hooke theorized that a constant supply of fresh air could keep human lungs alive. He demonstrated his discovery by opening a dog’s chest and pumping air in and out of the lungs. The dog lived and probably won’t fly today.
This idea was further proven when a surgeon named William Tossach succeeded in resuscitating a coal miner by blowing air into his mouth. Although this event did not occur until 1732, it appears to have been inspired by Hooke’s earlier discoveries.
In 1740, the Académie des Sciences in Paris declared that mouth-to-mouth resuscitation was the best method for rescuing drowning victims. Other medical hubs, such as London, England, continued to recommend the bellows method of resuscitation until 1829.
Two different methods of proto-CPR were developed in the 1700s.
The first method was a reversal. This involved dangling the victim’s feet from a rope. After hanging, the rescuer will pull it up and down. The goal was to expel water from the lungs while also applying pressure to the chest.
Another development is known as the barrel method. This is much more self-explanatory. Rescue workers laid the victim down on a bucket and rolled him back and forth. The goal of the method was to simulate lung mechanics through the addition and release of pressure to aid breathing.
Early CPR methods continued to be developed in the 1800s. The most notable of these were created in the 1850s and were known as the Hall and Silvester Methods.
British physician Dr. Marshall Hall developed a technique in which he rolls the victim from side to back while simultaneously applying hand pressure to the chest.
Dr. Henry Sylvester introduced a technique in which the victim lies on his back with his arms extended above his head. The rescuer rhythmically crosses the patient’s arms over the chest. This alternating movement of raising and crossing the arms provided the steady, repetitive pressure the lungs needed to expel air.
Significant changes began to occur in the 20th century. One of the most notable discoveries was made by a physician named George Crile. In his research, he discovered that chest compressions can restore blood circulation in humans. This was first achieved through experiments in dogs and later repeated in humans.
Due to new medical innovations, CPR practice underwent rapid changes in the 1950s.
Two doctors, James Elam and Peter Safar, showed that the air exhaled by a person performing resuscitation contained enough oxygen to keep another person alive.
This method was further expanded by doctors William Kouwenhoven, Guy Knickerbocker, and James Jude at Johns Hopkins and combined it with chest compressions. This was the birth of modern CPR.
Formal training in modern cardiopulmonary resuscitation (CPR) began in 1960 and was officially approved by the American Heart Association in 1963.
The term ‘CPR’ was also coined in 1960. The name comes from the two systems the bill seeks to support: the cardiovascular and pulmonary (also known as respiratory) systems.
By 1966, CPR was being taught to both professionals and the general public. However, early training was not very effective. During the first three months of training, less than half of the participants passed the performance assessment. This, combined with the fact that there is a high mortality rate among those performing CPR outside of hospitals, has led to the development of better training programs.
The American Red Cross has worked with more than 30 national organizations to develop national guidelines for CPR training and practice. One of the most notable was the recommendation to perform cardiopulmonary resuscitation (CPR) on mannequins.
Today, CPR is performed using proven techniques and guidelines. Up to 65% of all Americans have undergone this training at least once in their lives.
In addition to CPR, a defibrillator is also commonly used. A defibrillator is a device that restores the victim’s heart rate to a natural rhythm by delivering an electric shock to the victim.
The first successful use of a defibrillator was by Claude Beck in 1947. However, it involved surgically opening the chest and delivering a shock directly to the heart.
A closed-breasted version was proven successful in the 1950s by the aforementioned Dr. William Kouwenhoven. He discovered that a defibrillator could be used to shock the heart from outside the body using methods such as CPR, as long as circulation continued.
Because the original defibrillators were large and heavy, methods were developed to miniaturize them. The goal was to create a tool that anyone could use, not just experts.
Careful development has made defibrillators more practical. The latest version is lighter and more portable. They store enough energy to shock the heart to restore heart rate.
Defibrillators, such as automated external defibrillators (AEDs), are very effective in saving lives after cardiac events. The device can be used on both adults and children and is FDA approved.
If used immediately after AED administration, the chance of survival is 10 to 70 percent. Each time treatment is delayed in a cardiac emergency, the chance of survival decreases by 10%.
Efficiency has led to changes to ensure CPR and AED knowledge is ubiquitous.
Most U.S. states require schools to teach CPR to both students and teachers. This helps significantly increase the number of people ready to administer CPR when needed.
AEDs have also been installed in many public places. This change was primarily made as part of an effort called Project Adam.
In 1999, a 17-year-old Wisconsin student named Adam Lemel tragically collapsed and died while playing basketball. This incident led to the creation of a project named in his honor.
Sadly, Adam’s death was one in a series of deaths. In southern Wisconsin, several children have died from ventricular fibrillation, which causes the heart to quiver without pumping blood.
Heart disease can be treated with AEDs, which help restore the heart to its normal rhythm. In Adam’s case, his chances of survival would have drastically improved if he had had an AED.
Established on July 1, 2001, Project Adam was established to promote nationwide AED implementation within school systems.
The initiative focuses on raising awareness of acute cardiac arrest in educational settings while ensuring these institutions have all the equipment and training necessary to respond effectively to emergencies.
I’m just a podcaster and this is just a podcast, so nothing I cover in this episode should be considered medical training. If you are interested in learning CPR, and everyone should be, the easiest way is to enroll in a training course at your local Red Cross organization.
Registering for an online training session is easy. Many courses include online sessions and face-to-face skills assessments. These sessions are fairly short depending on your class and skill level and are valid for two years.
CPR is one of the often overlooked medical advancements of the 20th century. Unlike other advancements, there is no need for hospitals or doctors. This is something anyone can do.
