Cardiopulmonary resuscitation, widely known as CPR, is a life-saving technique in emergency medicine. This procedure combines chest compressions with artificial ventilation to maintain blood flow and oxygen delivery to the brain and other vital organs when a person’s heart has stopped beating effectively. It is a cornerstone of first aid and emergency response globally.
From Ancient Practices to Early Attempts
Attempts to revive individuals who appeared lifeless date back centuries, with rudimentary methods appearing in ancient texts. Ancient Egyptian literature, for instance, contains references to practices that conceptually link to artificial ventilation. Early efforts were largely unsystematic and based on limited scientific understanding, often involving techniques like applying heat, flagellation, or using bellows to inflate lungs.
The 18th century marked a period of renewed interest in resuscitation, particularly for drowning victims. In 1740, the Paris Academy of Sciences formally recommended mouth-to-mouth resuscitation to revive individuals. Early humane societies, like the Society for the Recovery of Drowned Persons in Amsterdam (1767) and the Royal Humane Society in London (1774), also emerged. These organizations promoted techniques such as warming and artificial respiration with bellows, though some methods like tobacco smoke enemas were later discredited.
The Dawn of Modern Cardiopulmonary Resuscitation
Modern CPR developed from scientific advancements in the mid-20th century. In the 1950s, Austrian anesthesiologist Peter Safar conducted groundbreaking research proving the effectiveness of mouth-to-mouth resuscitation in maintaining blood oxygen levels. His work, often conducted with James Elam, demonstrated that expired air was sufficient for adequate oxygenation, leading to the adoption of mouth-to-mouth ventilation by the U.S. military in 1957.
Concurrently, a team at Johns Hopkins University discovered external chest compressions. In 1958, electrical engineer William Kouwenhoven, alongside his graduate student Guy Knickerbocker and cardiac surgeon James Jude, observed that rhythmic pressure on the chest could maintain circulation. This observation, initially made during defibrillation experiments on animals, led them to develop a technique of external cardiac massage. Their research showed that chest compressions could sustain about 40% of normal circulation.
Combining these two techniques formed the basis of modern CPR. In 1960, these resuscitation pioneers—Kouwenhoven, Safar, and Jude—presented their combined approach of mouth-to-mouth breathing with chest compressions. The American Heart Association (AHA) formally endorsed CPR in 1963, initiating programs to educate physicians on this combined technique.
Widespread Adoption and Continuous Evolution
Following its formal endorsement, CPR quickly moved toward widespread adoption and standardization. In 1960, the first CPR training manikin, Resusci Anne, was created through a collaboration involving Peter Safar, James Elam, and Asmund Laerdal, a Norwegian toymaker. This innovation facilitated CPR training for medical professionals and the general public. By 1966, the National Research Council of the National Academy of Sciences convened a conference to establish standardized training and performance guidelines for CPR at the request of organizations like the American Red Cross.
Training programs, emphasizing the “ABC” (Airway, Breathing, Circulation) approach, were developed by organizations like the American Heart Association and American Red Cross. Ongoing research has led to continuous evolution of CPR techniques. This includes automated external defibrillators (AEDs), which deliver an electric shock to restore a normal heart rhythm. More recently, Hands-Only CPR has gained prominence, particularly for untrained bystanders, focusing solely on chest compressions to simplify the procedure and encourage immediate action.