LaHood, Nicole

Moukabary, Talal

English

Via Medica Journals

www.cardiologyjournal.org 487HISTORY OF CARDIOLOGYCardiology Journal2009, Vol. 16, No. 5, pp. 487–488Copyright © 2009 Via MedicaISSN 1897–5593History of cardiopulmonary resuscitationThe history and practice of cardiopulmonary re-suscitation (CPR) brings together developments inthree main fields. The first to develop was basic lifesupport, followed by advanced life support, andlater prolonged life support.These three processes have evolved overmany centuries, with the first accounts dating backto biblical times. However, consistently recordedmedical success of CPR methods only appeared inthe early nineteenth century. Advances in this areahave progressed rapidly from the middle of thetwentieth century up to the modern era.Ancient Hebrew scripture and the Old Testa-ment both describe the resuscitation of a young boyby the prophet Elijah. This is possibly the first do-cumented account of life support. In the King JamesBible, II Kings 4:34 reads: “And he went up, andlay upon the child, and put his mouth upon hismouth, and his eyes upon his eyes, and his handsupon his hands: and he stretched himself upon thechild; and the flesh of the child waxed warm.” [1].Although it is obviously uncertain that this is anactual account of artificial respiration, it is possible.However, speculation aside, the earliest accountsof resuscitative events are primitive by today’sstandards and associate life with observed physicalcharacteristics such as breathing, warmth, andmotion. The ancient Chinese would immerse theirdying in hot oil baths to restore life. Native Ameri-cans placed fresh animal dung (thought to containlife) on the dying person’s abdomen [2]. Other com-mon futile practices before the eighteenth centuryincluded vigorous stretching of the tongue or anus,hanging the victim upside down and alternately rais-ing and lowering them, and placing them on a trot-ting horse to induce animation [2]. More effectivemethods of basic life support were not proposeduntil around the mid-eighteenth centuryBasic life support encompasses the develop-ment of three major practices: airway control, arti-ficial respiration, and cardiac massage.Vesalius is credited with the earliest accountof artificial respiration and airway control in 1555when he used a reed placed in the trachea of ani-mals to keep them alive while studying their ana-tomy [3]. In 1732, Tossach performed the first do-cumented resuscitation of a coal miner overcomeby fumes, using mouth-to-mouth [2–4]. Some yearsafter Tossach received public attention for his work,the Paris Academy of Sciences recommendedmouth-to-mouth resuscitation for the newlydrowned [3]. Mouth-to-mouth resuscitation was notpopular for hygienic reasons and the belief that thecarbon dioxide in exhaled air was harmful if carriedinto the lungs of the victim [2]. Soon thereafter,manual methods of artificial respiration were intro-duced. The progress of each new manual method,such as the bellows method (initiated by PhillippusAureolus Paracelsus [2]) and the mouth-to-masktechnique, prompted the Royal Humane Society torecommend the bellows technique over the mouth--to-mouth technique in 1782 [2]. In the early 1800s,Leroy d’Etiolles was the first to manipulate theposition of the body to induce ventilation. In 1829he introduced a procedure of resuscitation that in-volved alternating compression of the victim’s chestand abdomen [2]. The most popular methods ofmanual (postural) resuscitation from the 1850s tothe 1950s included Hall’s rolling method, Howard’sthoracic compression method, Sylvester’s chestpressure/arm lift method, Schaefer’s prone pres-sure method, and the Holger-Nielsen prone backpressure/arm lift method [2, 5, 6]. Eventually somepublications began to favor mouth-to-mouth resus-citation once again. However, it wasn’t until 1958when Safar, Escarraga, and Elam published the firstdefinitive study that established the superiority ofmouth-to-mouth resuscitation over manual me-thods. This led the National Research Council of theNational Academy of Sciences to recommendmouth-to-mouth resuscitation as the emergencytechnique of choice that same year [2, 3].The late 1800s also witnessed the developingpractice of cardiac massage. The first successful useof closed chest cardiac massage in living cats is at-tributed to Bohem of Germany and his associates[3, 5]. In 1880 Niehaus performed the first unsuc-cessful attempt at closed chest cardiac massage ina man [3]. Five years later, Koenig reported eightsuccessful cases of human closed chest cardiacmassage [3]. Although experimental and in-hospi-tal trials of closed cardiac massage continued, it wassoon replaced by the assumedly superior and moreinvasive method of open chest cardiac massage.488Cardiology Journal 2009, Vol. 16, No. 5www.cardiologyjournal.orgIn 1898 Tuffier and Hallion reported the first tem-porary success of open cardiac massage in man, andIgelsrud performed the second successful openchest cardiac massage three years later [3].Eventually researchers, scientists, and physi-cians began to combine the known techniques ofresuscitation in the hope of producing even moreeffective procedures. Early in the twentieth centu-ry, George Washington Crile wrote an extraordinaryreport about an experimental method of animal re-suscitation combining the use of thoracic compres-sion, artificial respiration, and parenteral epine-phrine infusion [3, 6]. In this report he describedopen and closed cardiac massage and anticipated the‘thoracic pump theory’ by stating: “Pressure uponthe thorax alone is capable of producing an artifi-cial circulation. This is by no means accomplishedby its action upon the heart solely, but by its actionupon all the large vessels: arteries, veins and capil-laries together.” [6].The article also contained documented casesof successful closed chest cardiac massage in dogsand man, and the first ‘MAST’ suit description anduse [3]. In 1960 Kouwenhoven, Jude and Knicker-bocker reported the successful use of closed chestcardiac massage in 20 patients ranging in age from20 months to 80 years, with a 70% survival rate [2].Their article’s well-documented successes in closedchest cardiac massage reinforced its efficiency.Eventually, closed chest compressions and artifi-cial ventilatory techniques were combined to pro-duce the method of cardiopulmonary resuscitationmost commonly used today. The success of Crile’s,Kouwenhoven’s and many other scientist’s workled to an improvement in basic life support, andopened the door to the progression of advanced andprolonged life support.Experimental developments in the field of elec-trical resuscitation began in the mid to late 1700sbut did not flourish until the early to mid 1800s.Around 1775, reports of experimental tests usingcrude, homemade batteries to induce electrical de-fibrillation began to emerge. Danish veterinarianand physician Peter Abildgaard conducted experi-ments with the effects of electrical shock and coun-tershock in animals, and the ‘Squires of London’reported a cardiac arrest and resuscitation usingelectrical defibrillation [2, 3]. Experimentation con-tinued though out the 1800s by scientists such asDr. Allan Burns of Glasgow who suggested infla-tion of the lungs and shock to the chest for resusci-tation (1809), and Prevost and Battelli, who in 1899thoroughly studied the effects of electrical shock onthe mammalian heart [2, 3].In 1947, Claude Beck performed the first suc-cessful internal defibrillation of a human heart in theoperating room, and in 1956 Zoll et al. performedthe first human external defibrillation [2, 7].Without a doubt, the history of cardiopulmo-nary resuscitation portrays the advances in resus-citative medicine through the application of scien-tific method and an undeviating resolve to questionaccepted common practice. Although the field ofCPR has seen much growth already, as health careproviders we can only expect that the road aheadwill lead to numerous discoveries and changes thatwill further shape resuscitative practice.References1. The Holy Bible. King James Version.2. Hermreck AS. The history of cardiopulmonary resuscitation.Am J Surg, 1988; 156: 430–436.3. DeBard ML The history of cardiopulmonary resuscitation. AnnEmerg Med, 1980; 9: 273–275.4. Whitby JD. Two early artificial ventilators. Br J Anaesth, 1973;45: 391–393.5. Safar P. Initiation of closed-chest cardiopulmonary resuscitation ba-sic life support. A personal history. Resuscitation, 1989; 18: 7–20.6. Paraskos JA. History of CPR and the role of the national confe-rence. Ann Emerg Med, 1993; 22: 275–280.7. Jude JR. Personal reminiscences of the origin and history ofcardiopulmonary resuscitation (CPR). Am J Cardiol, 2003; 92:956–963.Nicole LaHoodTalal Moukabary, MDUniversity of Arizona, Tucson, AZ, USAe-mail: talal@moukabary.com

History of cardiopulmonary resuscitation

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History of cardiopulmonary resuscitation

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