How many of you have ever seen CPR performed on a victim? Better yet, how many of you have performed it yourself? If
you’ve never seen or done it in person, I’m sure you’ve witnessed the hokey
representations on TV, where the medical crews pump on the victim’s chest for a
few minutes and are rewarded when the patient sits up and says “howdy.”
Unfortunately, it doesn’t really work that way.
This week, as part of my paramedic renewal,
I completed my recertification in Advanced Cardiac Life Support (ACLS). ACLS
provides guidelines for cardiac emergencies, including CPR, drugs, and advanced techniques, such as airway procedures and defibrillation. The certification must be renewed every two years, so that providers remain proficient in their skills and informed of guideline changes.
I’ve been cramming for the past week, studying EKG
strips, calculating drug dosages, and memorizing the latest protocol changes in
an effort to avoid embarrassing myself during my exams. All that studying got me
thinking about the history of cardiopulmonary resuscitation (CPR) and how far
we’ve come in our attempts to revive the dead. So let’s take a peek at this
convoluted history.
First, for those unfamiliar with the basics of
CPR, let me give you a brief overview. If someone goes into cardiac arrest, CPR, when performed properly, provides breathing and
circulation for the downed victim. Compressions to the chest circulate the blood, thereby oxygenating the tissues, and ventilations done mouth-to-mouth (or
better yet, mouth-to-mask) provide the necessary oxygen. These measures,
performed as soon as the victim collapses, greatly improve his chance of
being revived, since the longer one goes without circulation,
the less likely one is to respond to advanced treatments.
Early medical practitioners understood the basics,
even though it took them a while to put the pieces together in a coherent
strategy. As far back as the 1500s, the physician and anatomist, Andreas
Vesalius, realized that animals could be kept alive by forcing air into their
lungs. The alchemist, Paracelsus, tried resuscitating a corpse using bellows, a
technique he lifted from ancient Arabic medical scripts. And there are even
references to mouth-to-mouth in the Bible. Elisha is reported to have breathed
into a child in order to revive him, so apparently people have been dabbling in
artificial respirations for quite some time.
It wasn’t until the 1740s that the Paris Academy of Sciences publicly recommended mouth-to-mouth for drowning victims. But
following the discovery of oxygen in the 1770s, practitioners decided the
exhaled air delivered via mouth-to-mouth was too deoxygenated to be of much
use. Mechanical methods had also fallen out of favor after a few mishaps with
the bellows (apparently it’s pretty easy to blow out someone’s lungs if you’re
not sufficiently trained), so the idea of artificial respirations fell by the
wayside and the focus shifted to chest compressions.
It was well understood by this time that blood
circulated throughout the body and that circulation was fundamental to life
(battlefield injuries probably provided the obvious link between bleeding and
rapid death). A Mr. Moritz Schiff, in 1874, noted that pumping the chest of a
dead dog produced a carotid pulse, and word of his canine cardiology quickly
spread. It was soon tried out on felines when Rudolph Boehm and Louis Mickwitz
successfully resuscitated a kitty by squeezing its chest and ribs. But it
wasn’t until the 1890s that Friedrich Maass actually applied it to a human.
Unfortunately, the concept of cardiac massage would also fall by the wayside for the next seventy years, until 1958, when William Kouwenhoven reintroduced chest compressions in treating the pulseless.
Unfortunately, the concept of cardiac massage would also fall by the wayside for the next seventy years, until 1958, when William Kouwenhoven reintroduced chest compressions in treating the pulseless.
Through trial and error, it was finally established that a combination of ventilations and chest compressions could provide adequate respirations and circulation for victims of cardiac arrest. Lifesaving took another giant leap forward with the discovery of electricity and its effect on the heart. Since the heart relies on electrical impulses to generate a pulse, and certain types of cardiac arrest are due to erratic electrical impulses (known as fibrillation), researchers devised a method of delivering a shock to the heart that could correct the dysrhythmia. Thus the tried and true technique of cardiac defibrillation was born.
