History of Cardiopulmonary Resuscitation - Recent Developments in CPR

Recent Developments in CPR

By the early 1970s CPR, defibrillation, and a rapid means to provide prehospital care were all in place. The structure to resuscitate sudden death victims had been built and was proving successful. That most of the world did not have this structure in place in the 1970s was largely due to lack of diffusion and spread of the ideas, rather than the impossibility of carrying them out.

However, the story of resuscitation does not stop in the early 1970s. Major advances have continued. In 1980 the first program to train EMTs to perform defibrillation began in King County, Washington, and similar programs spread throughout the United States. This training required 10 hours, and in the first demonstration project, survival from ventricular fibrillation increased from 7% to 26% (ref). In 1984 the first program with fire fighter EMTs using automated external defibrillators (AEDs) also began in King County, Washington. The use of AEDs simplified the training of EMTs and thus allowed the procedure to spread more rapidly throughout communities. Automated external defibrillators require considerably less training time compared to manual defibrillators since the EMT does not have to interpret the cardiac rhythm.

The idea for an automated defibrillator was first conceived by Dr. Arch Diack, a surgeon in Portland, Oregon. His prototype, literally assembled in a basement, utilized a unique defibrillatory pathway – tongue to chest. There was a breath detector that was a safeguard to prevent shocking breathing persons. The electrode was essentially a rate counter, far cruder than today’s sophisticated VF detectors. The production model weighed 35 pounds and gave verbal instructions. It was an idea ahead of its time. Most people viewed it as a curiosity. By the late 1980s, however, other manufacturers entered the field leading to the automated external defibrillators (AEDs) we have today. Current AEDs, like regular defibrillators, use electrode pads attached to the chest. AEDs are programmed to guide the operator (with a series of voice prompts) through the procedure. The pads once attached automatically detect the type of heart rhythm and if VF is present the AED instructs the operator to press a button (usually flashing red) to shock the patient. From EMT defibrillation with AEDs, there was a natural and logical progression to first responder defibrillation (AEDs used by police or security personnel), next widespread Public Access Defibrillation (AEDs used by lay persons in public locations such as airports, schools, exercise facilities, etc.) and finally home AED including the opportunity to purchase AEDs over the counter without a prescription.

In 1981 a program to provide telephone instructions in CPR began in King County, Washington. This program used the emergency dispatchers to give instant directions while the fire department EMT personnel were en route to the scene. This demonstration project increased the rate of bystander-provided CPR by 50%. Dispatcher-assisted CPR is now standard care for dispatcher centers throughout the United States and in other countries such as Israel, Great Britain, Sweden, and Norway.

The American Heart Association uses a metaphor of four links in a chain to describe the elements of successful resuscitation. These links are early access (recognizing cardiac arrest and calling 911), early CPR, early defibrillation, and early advanced care (such as medications, endotracheal intubation) The early paramedic programs were all designed to provide CPR, defibrillation, and advanced care quickly enough to resuscitate patients in cardiac arrest.