A history of cardiopulmonary resuscitation (CPR)

| August 1, 2013

Cardiopulmonary resuscitation (CPR) is a lifesaving technique (composed of chest compressions followed by mouth-to-mouth breaths) intended for those whose breathing or heartbeat has stopped, such as victims of heart attacks or drowning. For decades, CPR prioritized mouth-to-mouth resuscitation as the first step in providing care.

CPR instructions

Many restaurants will put up signs like this one to serve as emergency CPR instructions (view this sign here).

Ironically, mouth-to-mouth resuscitation, a technique rooted in antiquity—the Bible describes midwives performing the practice to resuscitate newborns—was largely forgotten until the 1950s when doctors James Elan and Peter Safar reintroduced the practice.

Prior to that time, chest compression was the method for reviving patients or those needing emergency care. In 1858, for example, British physician Henry Robert Silvester developed a method in which a subject was laid on her back and air drawn into her lungs by taking her arms, pressing them over her chest, and then pulling them over her head. The sequence was then repeated sixteen times per minute.

Another practice, called the Holger Nielsen technique, was introduced in 1911. It replicated many elements of the Silvester Method, except it required the subject to be placed on his stomach. His arms were then bent at the elbows and his hands, overlapping one another, and were then placed beneath his head, which was turned sideways. Next, the caregiver would place his hands on the middle of the subject’s back just below the armpits and then, using his full body weight, press and immediately draw the subject’s arms upwards until resistance was felt. Like the Silvester Method, the procedure was repeated sixteen times per minute.

Both practices fell out of favor in the 1950s when doctors Elan and Safar combined compression with mouth-to-mouth resuscitation, with the latter given primacy. Indeed, the American Heart Association (AHA) even developed an easy-to-remember acronym for the procedure’s steps: ABC or Airway, Breathing, Compression. Emergency care providers were told to open a victim’s airway by tilting the head back, pinching the nose, breathing into the mouth, and then compressing the chest.

CPR instructions sign

The new procedural acronym (view this sign here).

However, the association reorganized the steps in 2010; research showed that rescuers who began CPR by opening the airway took 30 seconds longer to start compression than those who immediately began the procedure with chest compressions. This was an important finding because, in the first few minutes of cardiac arrest, all victims still have oxygen in their lungs and bloodstream. Beginning CPR with chest compressions can pump that oxygenated blood to the victim’s heart and brain sooner, thereby delaying brain damage caused by lack of oxygen.

Today the AHA has reordered the acronym to read: CAB or Compression, Airways, Breathing.

But many rescues are compromised by caregivers’ hesitation to offer help, due either to their lack of training or their insecurity over the training they’ve received. The Mayo Clinic recommends choosing action over inaction, however. The difference between doing nothing and taking action could be someone’s life, says the clinic.

Make sure your signs are updated with the new CPR standards.

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