Cardiopulmonary Resuscitation (CPR) is an emergency technique used to maintain blood and oxygen flow to the brain and vital organs when someone’s heart has stopped or they are not breathing effectively. The brain can suffer irreversible damage within minutes without adequate oxygen, making immediate action essential for survival. CPR aims to sustain life until professional medical assistance arrives, improving the chances of a positive outcome.
Early Resuscitation Attempts
Before modern medical understanding, various methods were used to revive individuals. Ancient texts from Egypt and Greece describe early, rudimentary resuscitation attempts. For instance, the Greek physician Galen (second century A.D.) documented efforts to inflate animal lungs using bellows, a technique used in Europe for centuries. Other practices included flagellation, applying heat, or rectal fumigation with tobacco smoke, reflecting a persistent desire to restore life.
The 18th century saw renewed interest in resuscitation, especially for drowning victims. In 1732, Scottish surgeon William Tossach successfully revived a coal miner using mouth-to-mouth resuscitation, a method recommended by the Paris Academy of Sciences in 1740. Organizations like Amsterdam’s Society for the Recovery of Drowned Persons (1767) emerged to standardize early techniques. While manual methods like the Marshall Hall and Silvester techniques gained favor in the 19th century, mouth-to-mouth breathing largely fell out of use until the mid-20th century.
The Genesis of Modern CPR
Modern CPR began to solidify in the mid-20th century. In 1954, American anesthesiologist Dr. James Elam demonstrated that expired air contained sufficient oxygen for resuscitation. His work proved the effectiveness of mouth-to-mouth ventilation, a technique overlooked for decades.
In 1956, Austrian anesthesiologist Dr. Peter Safar collaborated with Elam, confirming mouth-to-mouth resuscitation’s efficacy through human volunteer experiments. Safar’s research also laid the groundwork for the “ABCs” of resuscitation—Airway, Breathing, and Circulation—emphasizing a systematic approach to emergency care. His efforts led to training tools like the Resusci Anne mannequin.
Simultaneously, at Johns Hopkins University, research led to the chest compression component of CPR. In 1958, Dr. William Kouwenhoven, Dr. James Jude, and Dr. Guy Knickerbocker observed that rhythmic pressure on a dog’s chest during defibrillation experiments generated blood flow. This showed external chest compressions could maintain circulation when the heart stopped. In 1960, Drs. Jude, Safar, and Kouwenhoven combined mouth-to-mouth ventilation and external chest compressions, establishing the unified technique of cardiopulmonary resuscitation. Their published findings marked modern CPR’s formal inception.
Global Recognition and Training
After its development, CPR rapidly gained medical and public recognition. The American Heart Association (AHA) formally endorsed CPR as a life-saving technique in 1963, leading to efforts to standardize training and performance. In 1966, the National Research Council established CPR guidelines, solidifying its medical application.
The 1970s advanced CPR accessibility for the general public. In 1972, the AHA launched its first CPR course for healthcare workers, combining classroom learning with hands-on practice. That same year, Leonard Cobb initiated Seattle’s Medic II program, the first major public CPR training program in the United States. Public awareness campaigns, like the AHA’s “Friends and Family” initiative in the 1980s, continued to promote training. CPR guidelines evolve with ongoing research, including hands-only CPR in 2008 to encourage bystander intervention.