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HIGHLIGHHTS FROM THE 16th century to the 21st century
Resuscitation: It’s as old as the healing arts, as new as a drone delivering an automated external defibrillator (AED). And from primitive methods (like whipping an unconscious victim with stinging nettles) to modern-day cardiovascular pulmonary resuscitation (CPR), the evolution of resuscitation has been marked by profound aha! moments alongside decades of abandoned lifesaving methods. These are just a few highlights from the intricate and fascinating history of CPR.

1700s

1530-1800s, Europe The Bellows Method first used by Swiss physician Paracellsus. Reprinted by permission from Chicago's Museum of Science and Industry1.

1732 In Alloa, Scotland, local surgeon William Tossach uses mouth-to-mouth breaths to revive a suffocated coal-pit miner. Dr. Tossach documents the success 12 years later, in what may be the first clinical description of mouth-to-mouth resuscitation in medical literature.

1740 The Academie des Sciences in Paris officially recommends mouth-to-mouth resuscitation for reviving victims of drowning.2

1774 London physicians William Hawes and Thomas Cogan found the Society for the Recovery of Persons Apparently Drowned (later to become The Royal Humane Society) to assist victims of sudden and unexpected death.

1775 Experimenting with animals, Danish veterinarian Peter Abildgaard discovers that after rendering a chicken lifeless by shocking it, countershocks to the chest could restore a heartbeat.3

1782 The Royal Humane Society expresses its preference for using bellows rather than mouth-to-mouth ventilation to artificially inflate the lungs.4

1800s

The Hall and Silvester methods become the most commonly used forms of artificial respiration until the early 20th century.5

Photo courtesy of Laerdal Medical Corporation. 1856-Marshall Hall Method. Chest elevated, a victim is pulled up on his side momentarily, then rolled back. Pressure on back expelled air.Photo courtesy of Laerdal Medical Corporation. 1861-Silvester Method Victim on back, arms over head. Arms moved forward, folded on chest and pressed. Tongue held, keeping air passage open.1856 London physician Marshall Hall introduces his simple resuscitation technique: alternately repositioning the patient from faceup to side. He updates the approach by adding pressure on the thorax.6

1858 Henry Silvester, another London physician, creates the chest-pressure arm-lift method: raise the patient’s arms up to expand the chest, then cross the arms over the chest to apply expiratory pressure.7

1874 German physiologist Moritz Schiff’s research on animals in Florence, Italy8 reveals that massaging the heart during surgery can restore circulation.

1878 In Germany, Rudolph Boehm shows that external compressions of the heart provide adequate circulation in cats.9

1891 After using external compressions to restart the hearts of 2 young human patients, German surgeon Dr. Friedrich Maass becomes the first to advocate chest compressions, rather than ventilation alone, to help with circulation.10 But the technique doesn’t take hold, and for the next half century, open-heart massage is the standard.

1900-1940s

Doctor George Crile

1903 In Cleveland, Ohio, Dr. George Crile’s research confirms that external chest compressions restore circulation in dogs.11

1904 Dr. Crile reports successful closed-chest cardiac massage in 1 human case.12 But once again, the noninvasive technique doesn’t gain traction, and patients continue to receive open-heart massage.

1933 Researchers at Johns Hopkins University, led by electrical engineer William Kouwenhoven, PhD, accidentally rediscover external compressions when they find that pressure on a dog’s sternum provides adequate circulation to the brain to keep the animal alive until defibrillation can restart its heart. Their results are confirmed in more than 100 dogs.13

1924 Six cardiologists meet in Chicago and form the American Heart Association (AHA) as a professional society for physicians. Nearly a century later, the AHA will be the world leader in CPR and emergency cardiovascular care (ECC) training and education.

A canine patient in Kouwenhoven’s lab, revived by the team’s experimental combo: external chest compressions and defibrillation.

1947 In Cleveland, Ohio, cardiothoracic surgeon Dr.Claude Beck performs the first successful use of an electric defibrillator on an exposed human heart.14

1950s

The original American Heart Association logo depicting a torch within a heart.1950 The AHA begins publishing Circulation, a scientific journal that informs doctors, researchers, and others about cardiovascular breakthroughs.

1954 American physician and respiratory researcher Dr. James Elam becomes the first person to prove that expired air is sufficient to maintain adequate oxygenation.15

1956 Dr. Elam and Dr. Peter Safar prove that mouth-to-mouth resuscitation is an effective lifesaving method. Drs. Elam, Safar, and Archer Gordon play leading roles in promoting rescue breathing to professional healthcare providers and the public alike.16

Dr. Safar performs mouth-to-mouth resuscitation in Baltimore, 1957. Reprinted by permission from the Safar Center for Resuscitation Research.

For the first time in human medicine, an external defibrillator successfully restores a steady rhythm to a quivering heart. Harvard cardiologist Dr. Paul Zoll leads the study with funding from the AHA.

1957 The United States military adopts the mouth-to-mouth resuscitation method to revive unresponsive victims.

A Hopkins Closed Chest Defibrillator. Photo courtesy of Johns Hopkins Magazine. (l to r) Dr. James Jude, William Kouwenhoven, and Guy Knickerbocker. Reprinted by permission from the Veterinary Emergency and Critical Care Society.

Johns Hopkins team unveils first portable external defibrillator

1957 After several years of research on closed-chest defibrillation, Dr. Kouwenhoven’s team at John’s Hopkins, which includes James Jude, MD, and Guy Knickerbocker, PhD, unveils its prototype of the first portable external defibrillator (on a wheeled cart): the 200-lb Hopkins Closed Chest Defibrillator.17


1960s

1960 Resuscitation pioneers Drs. Kouwenhoven, Safar, and Jude combine mouth-to-mouth breathing with chest compressions to create cardiopulmonary resuscitation, the lifesaving actions we now call CPR.

The AHA starts a program to acquaint physicians with closed-chest cardiac resuscitation, which becomes the forerunner of CPR training for the general public.

Three variations of Resuscitation Anne manikin heads.

Resusci Anne is “born.”

1960 The life-size training manikin (a collaborative effort by Drs. Safar, Elam, and Gordon and Norwegian toymaker Åsmund Lærdal) goes on to teach CPR skills to more than 400 million people—and counting—worldwide.18

Resusci Anne through the ages:
1960-2018

 

1963 Cardiologist Dr. Leonard Scherlis establishes the AHA’s CPR Committee. That same year, the AHA formally endorses CPR.

1966 The National Research Council of the National Academy of Sciences convenes an ad hoc conference on cardiopulmonary resuscitation. The conference is the direct result of requests from the American National Red Cross and other agencies to establish standardized training and performance standards for CPR.

1970s

Dr. Leonard Cobb. Photo courtesy of the Medic One Foundation.

1972 In Seattle, University of Washington cardiologist Dr. Leonard Cobb launches Medic II, the world’s first mass citizen training in CPR.19 During its first 2 years, the program helps train more than 100,000 people.

1973 Second National Conference on CPR and ECC

1975 The AHA publishes the first Advanced Cardiovascular Life Support (ACLS) Textbook.


1980s

Black touch tone telephone1981 A program to provide telephone instructions for performing CPR begins in King County, Washington. The program trains emergency dispatchers to give callers CPR instructions while EMT personnel are in route to the scene. Fast forward to the 21st century: Dispatcher-assisted telephone CPR is standard in dispatch centers across the United States.

1983 The AHA convenes a national conference on pediatric resuscitation to develop CPR and ECC guidelines for pediatric and neonatal patients.

1985 Fourth National Conference on CPR and ECC

1988 In co-sponsorship with The American Academy of Pediatrics, the AHA introduces the first pediatric courses: pediatric BLS, pediatric advanced life support (PALS), and neonatal resuscitation.

1990s

Public access for AED, First Aid kit and emergency phone

1990 Fifth National Conference on CPR and ECC

1992 Founding of the International Committee on Resuscitation (ILCOR)

1999 The first task force on first aid is appointed. This year also sees the first International Conference on Guidelines for CPR and ECC.

early 2000s

The first Pediatric Advanced Life Support textbook.

2005 The AHA develops the Family & Friends® CPR Anytime® kit, an innovative product that enables anyone to learn the core skills of CPR in just 20 minutes. The kit provides everything needed to learn basic CPR, AED skills, and choking relief anywhere, from a family room at home to a setting for instructing large groups.

The 2005 International Consensus on CPR and ECC Science With Treatment Recommendations (CoSTR) Conference leads to the AHA publishing the 2005 AHA Guidelines for CPR and ECC. The Guidelines recommend a new compression-to-ventilation ratio of 30:2 as well as changes to AED usage.

2008 The AHA releases new recommendations that say bystanders can skip mouth-to-mouth resuscitation and use Hands-Only CPR to help an adult who suddenly collapses.20 In Hands-Only CPR, bystanders dial 9-1-1 and provide high-quality chest compressions by pushing hard and fast in the center of the victim’s chest.

2010 After the 2010 International CoSTR Conference, the AHA publishes the 2010 AHA Guidelines for CPR and ECC. 2010 also marks the 50th anniversary of CPR.

Various people positioned on their knees learning Hands-Only CPR during a live demonstration

Hands-Only CPR Hits the Road to Save Lives

2012 The AHA's Hands-Only Mobile Tour hits the road to teach Hands-Only CPR across the country.

AHA's Hands-Only CPR mobile tour visits southern Maine.

 
A man performing Hands-Only CPR on a kiosk manikin.

2013 The AHA installs an interactive CPR kiosk at Dallas-Ft. Worth airport. It features a practice manikin, video, and touch screen that give performance feedback as passengers between flights learn to perform hands-only CPR. Within 5 years, there will be more than 30 CPR kiosks in cities across the country.

2015 The Institute of Medicine releases its report Strategies to Improve Cardiac Arrest Survival: A Time to Act (2015). After the 2015 International CoSTR Conference, the AHA publishes the 2015 AHA Guidelines Update for CPR and ECC.

2017 The AHA begins its continuous evidence evaluation process for the Guidelines for CPR and ECC and, later that year, releases the 2017 Focused Update.

2018 In June, the AHA publishes “Resuscitation Education Science: Educational Strategies to Improve Outcomes from Cardiac Arrest” in the journal Circulation. This statement, which is applicable to all resuscitation training programs (not exclusive to AHA), examines best practices in education and applies them to resuscitation. By implementing the statement’s guidance, training programs and resuscitation instructors will help raise the standard of care and increase survival from cardiac arrest.

Footnotes

Return to 1700s

1 Image 1530-1800s, Europe, The Bellows Method, first used by Swiss physician Paracelsus. Reprinted by permission from Chicago’s Museum of Science and Industry.

2 Baker AB. Artificial Respiration, The History of An Idea. Medical History. 1971;15(4):336-351. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1034194/pdf/medhist00129-0028.pdf (opens new window)

3 Cakulev I, Efimov IR, Waldo AL. Cardioversion: Past, Present, and Future. Circulation. 2009; 120:1623-1632. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2782563/(opens new window) ; Driscol TE, Ratnoff OD, Nygaard OF. The remarkable Dr. Abildgaard and countershock. The bicentennial of his electrical experiments on animals. Ann Intern Med. 1975;83(6):878-82 https://www.ncbi.nlm.nih.gov/pubmed/1106286 (opens new window)

4 Trubuhovich RV. History of mouth-to-mouth rescue breathing. Part 2: the 18th century. Crit Care Resusc. 2006;8(2):157-71. https://www.ncbi.nlm.nih.gov/pubmed/16749887 (opens new window)

Return to 1800s

5 Baskett TF. The Holger Nielsen method of artificial respiration. Resuscitation. 2007;74:403-405. https://www.resuscitationjournal.com/article/S0300-9572(07)00168-2/abstract (opens new window)

6 Baskett TF. Silvester’s technique of artificial respiration. Resuscitation.2007;74:8-10. https://www.resuscitationjournal.com/article/S0300-9572(07)00019-6/abstract (opens new window)

Photo courtesy of Laerdal Medical Corporation. 1856-Marshall Hall Method. Chest elevated, a victim is pulled up on his side momentarily, then rolled back. Pressure on back expelled air.

7 Baskett TF. Silvester’s technique of artificial respiration. Resuscitation. 2007;74:8-10. https://www.resuscitationjournal.com/article/S0300-9572(07)00019-6/abstract (opens new window)

Photo courtesy of Laerdal Medical Corporation. 1861-Silvester Method Victim on back, arms over head. Arms moved forward, folded on chest and pressed. Tongue held, keeping air passage open.

8 Vallejo-Manzur F, Varon J, Fromm Jr R, Baskett P. Moritz Schiff and the history of open-chest cardiac massage. Resuscitation. 2002;53:3-5. https://www.resuscitationjournal.com/article/S0300-9572(02)00028-X/abstract (opens new window)

9 Hurt R. Modern cardiopulmonary resuscitation—not so new after all. JR Soc Med. 2005;98(7):327-331. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1168923/ (opens new window)

10 Taw Jr. R. Dr. Friedrich Maass: 100th Anniversary of “New” CPR. Clin Cardiol. 1991;14:1000-1002. https://acilci.net/wp-content/uploads/2013/08/Dr.-Friedrich-Maass-100th-Anniversary-of-New-CPR.pdf (opens new window)

Return to 1900 to 1940s

11 Crile G. Blood Pressure in Surgery: an experimental and clinical research. Cartwright prize essay for 1903.  https://archive.org/stream/b21510842/b21510842_djvu.txt

12 Hurt R. Modern cardiopulmonary resuscitation—not so new after all. J R Soc Med. 2005;98(7):327-331. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1168923/

13 Beaudouin D. W.B. Kouwenhoven: Reviving the Body Electric. Johns Hopkins Engineering. 2002(Fall):27-32. https://engineering.jhu.edu/include/content/pdf/engmag02/27_32.pdf

14 Beaudouin D. W.B. Kouwenhoven: Reviving the Body Electric. Johns Hopkins Engineering. 2002(Fall):27-32. https://engineering.jhu.edu/include/content/pdf/engmag02/27_32.pdf

Return to 1950s

15 Sands RP, Bacon DR. An Inventive Mind: The Career of James O. Elam, MD (1918-1995). Anesthesiology. 1998;88:1107-1112. http://anesthesiology.pubs.asahq.org/Article.aspx?articleid=19476

Image Dr. Safar performs mouth-to-mouth resuscitation in Baltimore, 1957. Reprinted by permission from the Safar Center for Resuscitation Research.

16 Sands RP, Bacon DR. An Inventive Mind: The Career of James O. Elam, MD (1918-1995). Anesthesiology. 1998; 88:1107-1112. http://anesthesiology.pubs.asahq.org/Article.aspx?articleid=1947621

17 Beaudouin D. W.B. Kouwenhoven: Reviving the Body Electric. Johns Hopkins Engineering. 2002(Fall):27-32. https://engineering.jhu.edu/include/content/pdf/engmag02/27_32.pdf

Image A Hopkins Closed Chest Defibrillator. Photo courtesy of Johns Hopkins Magazine.

Image (l to r)Dr. James Jude, William Kouwenhoven, and Guy Knickerbocker. Reprinted by permission from the Veterinary Emergency and Critical Care Society.

Return to 1960s

18 Tjomsland, Nina. Saving more lives—together. The vision for 2020. 2015. Laerdal Medical Corporation.

Three variations of Resuscitation Anne manikin heads. Photo courtesy of Laerdal Medical Corporation.

Return to 1970s

19 History. Medic One Foundation website. https://www.mediconefoundation.org/who-we-are/history/

Dr. Leonard Cobb. Photo courtesy of the Medic One Foundation.

Return to early 2000s

20 History of the American Heart Association. American Heart Association website. https://www.heart.org/en/about-us/history-of-the-american-heart-association.