History of Cardiopulmonary Resuscitation - Modern Resuscitation

Modern Resuscitation

Scientists and doctors started to try and address the problem from many different sides including developing new medications, devising new surgical techniques and identifying risk factors. Doctors James Elam, Peter Safar and Archer S. Gordon set to educating the world about rescue breathing, preventive measures and trying to discover a way to treat acute cardiac arrest.

Gordon initially did not support rescue breathing until he performed a study of his own using pediatric patients, reproducing Elam's results. Safar had also been working on the feasibility of rescue breathing, so they agreed that a concerted effort would be much more valuable than each working separately and possibly reproducing each other's work.

Prior to the 1950s, the accepted method of resuscitation was the chest-pressure and arm-lift technique that was shown to be ineffective by Safar and Elam. In 1954, Elam was the first to demonstrate experimentally that exhaled air ventilation was a sound technique. Elam and Safar (and later Gordon) performed many experiments demonstrating the superiority of the rescue breathing technique. The problem then became one of popularizing the method.

Organizations such as the American Red Cross provide training at local chapters in the proper administration of artificial respiration procedures. The Red Cross has been teaching this technique since the mid-1950s. For example, in Kalamazoo, Michigan, volunteer Roger Mehalek introduced a breathing trainer called Miss Sweet Breath 1959, a plaster and plastic training mannequin he created.

In New York, then State Health Commissioner, Herman Hilliboe was impressed with the technique. He commissioned Elam to write the instructional booklet titled "Rescue Breathing," which was distributed nationally in 1959. The success of the booklet spurred Elam to produce films demonstrating this new life-saving technique.

By 1960, rescue breathing had been adopted by the National Academy of Science, American Society of Anesthesiologists, Medical Society of the State of New York and the American Red Cross as the preferred method of resuscitation.

Several key discoveries and understandings were required to treat the problem, which would take decades to work out, and even now is not 'solved'. Doctors speak of the natural history of diseases as a way to understand how therapy alters the usual progression of a disease. For example, the natural history of breast cancer may be measured in months but treated with surgery or chemotherapy the disease can be measured in years or even cured. Sudden cardiac arrest is a disease with an extremely rapid natural history, measured in minutes, with an inexorable outcome. But when treated with CPR the course of death can be extended (CPR will delay the dying process) and if treated with timely defibrillation death can be aborted.

The modern elements of resuscitation for sudden cardiac arrest are cardiopulmonary resuscitation (CPR in turn consists of mouth-to-mouth ventilation and chest compression), defibrillation and emergency medical services (the means to bring these techniques to the patient quickly).