CPR (cardiopulmonary resuscitation) is the method by which we attempt to cheat death after a person suffers cardiac arrest – when the heart stops beating. Historically, various interesting and potentially amusing techniques have been used to revive people, but CPR is a relatively recent development.
To begin our journey through the history of resuscitation science, we can begin with the Ancient Greeks. Galen, a philosopher and physician renowned for his anatomical observations and theories, is credited with the first attempt at inflating a dead animal’s lungs using bellows. He believed that the ceasing of lung function was what defined death.
The definition of death has progressed over the years, with modern ideas being that clinical death is when the heart stops beating, and biological death is when cells in the patient’s organs (namely the brain) die. I might suggest that with increasing success with reversing cardiac arrest, ‘death’ should be classified as when electrical activity in the brain comes to a halt.
The 18th century saw major developments in procedures to revive the dead, when public concern about people drowning was on the rise. The increasing number of drowning cases was due to industrialisation and the new widespread use of waterways, along with the fact that most people could not swim.
In 1767, the Academy of Sciences based in Amsterdam founded the ‘Society for Recovery of Drowned Persons’, who were the first to publicly recommend steps to take following someone’s cardiac arrest. Suggestions included lung inflation using either mouth-to-mouth or bellows, applying pressure to the abdomen, heating the person up, and bloodletting (causing the person to bleed, in this case often via the jugular).
A somewhat comical contemporary technique was stimulation by rectal fumigation with tobacco smoke. Like many treatments, the intention was to generate an expulsive response from the body by irritating it. Doctors also thought that, since drowning was due to a build up of cold wetness inside the body, introducing something hot and dry was key to restoring internal equilibrium. In reality, it was not the chemical properties of the tobacco but rather the excruciating discomfort caused by the nature of this strategy. Essentially, the shock would draw an unconscious person out of their ‘slumber’ and so the victim was considered revived. The equipment to facilitate public application of this procedure was installed along the River Thames by the Royal Humane Society in the 1780s.
An unfortunate yet expected side effect was increased transmission of infectious diseases such as cholera since someone would have to blow the smoke into the drowned person through a bellow. Despite it being a somewhat ridiculous-sounding idea, rectal fumigation is one of the first examples of entertaining the possibility of treatment after death, which proved to be revolutionary. Other methods included rolling corpses back and forth over barrels, as well as draping bodies over horses and sending them into a gallop. The scientific reasoning was that stimulation of the body, specifically the cardiopulmonary system, was clearly occurring.
It was not until the 20th century that modern CPR started to emerge. George Washington Crile is credited with the first successful revival of a patient using chest compressions (known as external heart massages at the time), and the introduction of administering adrenaline during cardiac arrest. German scientist Kouwenhoven had been developing the notion of electrical stimulation of the heart having shocked a dog’s heart back into action using heavy paddles – this also evidenced the benefits of putting pressure on the heart region. He crucially realised that “anyone can initiate cardiac resuscitation procedures anywhere." Thus, in 1960, he released a seminal paper outlining the process of CPR that we still use today.
CPR has drastically increased survival rates of cardiac arrest since members of the public can now maintain blood flow and oxygen supply to cells until medical help arrives. Nowadays, investigations into hypothermia treatment (as cooling the body slows any self-destructive metabolic processes due to anoxia in cells), magnesium administration (to prevent the influx of calcium which poisons cells), and artificial circulation (which works a bit like dialysis) are being researched. Widespread education about first aid and the instructions delivered in the moment by defibrillators mean that those who die outside of the hospital are being brought back at much higher rates.
References:
The Lazarus Effect by Dr Sam Parnia
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