The New CPR

Attempts at resuscitating a victim of cardiac arrest have a long and colorful past – and recent literature and thinking leaves no doubt that a new chapter is soon to be written.

Since the beginning of man, there have been endeavors to figure out how to resuscitate a person who has died. The first recorded attempt at resuscitation was contained in the Old Testament, when the Prophet Elijah performed mouth-to-mouth on Elisah: “…And we went up, and lay upon the child, and put his mouth upon his mouth, and his eyes upon his eyes, and his hands upon his hands, and he stretched himself upon the child; and the flesh of the child waxed warmed” (2 Kings 4:3). In 400 B.C., the writings of Hippocrates described intubation of the trachea to support ventilation.

Very early man realized the human body becomes cold when lifeless and is warm when a person is alive. When a person was dying, early man placed warm ashes and hot water directly on the body to keep it warm – thus attempting to prevent death. Other attempts with early man actually included flagellation, where the victim was whipped, in order to elicit some type of response.

In the 1500s, people attempted to breathe life into another person by using the bellows from a fireplace to blow air into the victim’s mouth. Apparently, there was some success with this method, as it was used for about 300 years and some have argued that a bellow was a precursor for today’s bag-valve mask. There may have even been more success with using bellows, but medical experts at the time did not have a clear understanding of anatomy and the respiratory system and did not know of the need to hyperextend the victim’s neck in order to open the airway.

In the 1700s, another method of resuscitation involved blowing smoke tobacco into an animal’s bladder, and then into the victim’s rectum. In 1829, the French physician Leroy d’Etiolles, in a demonstration showed an animal’s lungs could be overextended using bellows, so the practice was discontinued.

In 1770, the Inversion Method was developed in response to drowning, which was a leading cause of death in Europe at the time. The method involved hanging the victim by their feet. Raising and lowering the victim created pressure to aid expiration and inspiration.

In 1773, in a move to force air in and out of the victim’s chest, a rescuer would place the victim onto a large barrel and alternately roll him or her back and forth. By this action, the victim’s chest was compressed, forcing air out, and then a release of pressure allowed the chest to expand, resulting in air being drawn in. In 1803, the Russian Method included reducing the body’s metabolism by freezing the body under a layer of snow and ice. In 1812, lifeguards used a trotting horse to attempt to resuscitate a drowning victim. The victim was hoisted onto a horse and the horse was run up and down the beach. The bouncing on the horse resulted in alternate compression and relaxation of the chest cavity. However, the procedure was banned in 1815 as a result of complaints by “Citizens for Clean Beaches.”

Other methods of resuscitation around 1892 included stretching the rectum, rubbing the body, tickling the throat with a feather and waving strong salts such as ammonia under the victim’s nose. Another method described by French doctors included stretching the victim’s tongue. The procedure included holding the victim’s mouth open while pulling the tongue forcefully and rhythmically.

Mouth-to-mouth resuscitation as we know it today was advocated by the military in World War II. In the 1950s, the American Red Cross began a nationwide education campaign to educate the American public on mouth-to-mouth procedures. In the 1960s, the procedure was extended to lifeguard training and included using flotation devices to perform the procedure while still in the water.