Cardiac Chronicles: How CPR Has Evolved Over the Decades

Cardiopulmonary resuscitation (CPR) has undergone notable changes, updates, and improvements over the years. These changes are made all in favor of the rescuer – to adopt a simplified and effective approach that can save a victim of sudden cardiac arrest.

The reviving technique was officially recorded in the 1960s but appeared under a different name or ABCD, which stands for Airway, Breathing, Chest compression, and Defibrillation. However, other research states that a form of CPR was used as early as the 1400s in Persia.

In this article, we’re reviewing the evolution of CPR to see how it has improved to help the rescuers during the process and have satisfactory results. Therefore, let’s dive into the cardiac chronicles and talk about getting CPR-certified in Louisville, Kentucky.

Why Does CPR Change Over the Years?

Before we dive into the cardiac chronicles and look at how CPR has evolved over the decades, we need to clarify the need for CPR improvement.

Namely, after the initial ABCD protocol, the technique gets reassessed and updated every few years. Back in the day, there was a lack of research, knowledge, and most certainly a lack of instruments and technology to simplify the process for rescuers.

However, other factors also initiate changes in CPR protocols – a good example is the 2020 pandemic. Preventive measures of the pandemic required all rescuers to keep a distance and avoid mouth-to-mouth resuscitation or rescue breaths. The AHA had to find other alternatives to make CPR work effectively, even during uncertain times.

It has been a long journey – one of the most important ones. So, let’s see where CPR begins.

Oldest Records of CPR

The official introduction of CPR as a technique may have happened in the 1960s, but there is evidence that this technique was practiced in medieval Persia.

A medieval physician in the 15th century was the first physician who recorded providing chest compressions in his book. His name was Nafis ibn-Iwad al-Kermani, and he was born into a family of physicians where the knowledge was passed down from generation to generation. However, as he had the opportunity to work as a court physician, invited by the Prince of the Mughal Empire (Gurkani)—Ulugh Beg (1394–1449), Nafis started recording the diseases in his book.

Over the records of his experience with patients, he mentions practicing chest compressions by massaging the left side of the chest to establish cardiac circulation. In other words, he would first check for a pulse in the patient, and if it was weak, Nafis would start to shake them, move their arms, and provide compressions in the form of a massage – all to stimulate the heart and establish a steady rhythm.

After Nafis, there were many other attempts at CPR, but it is said that he was the original inventor. Later, with the Age of Enlightenment, there were other updates worth knowing.

CPR During the Age of Enlightenment

Back in 1732 in Aloa, a coal miner named James Blair apparently suffered a cardiac arrest and was considered dead for 30-45 minutes before the Scottish surgeon William A. Tossach provided rescue breaths to the victim, which surprisingly worked. James Blair returned to work a few days later.

In 1767, a group of locals in Amsterdam founded the Society for the Recovery of Drowned Persons, or SRDP for short. The Society focused on a range of resuscitation techniques to help drowning victims from the frequent floods in the city, including mouth-to-mouth resuscitation and methods for removing water from the lungs by correctly positioning the head and relieving the airways.

Sylvester’s and Nielsen’s Methods

Other interesting methods in the past were Sylvester’s and Holger Nielsen’s methods.

The initial CPR approach was placing the victim in a “/” position so that the head could drop back and pulling the victim’s hands over the head to imitate breathing in and breathing out by crossing and pressing the arms over the chest. A cycle of Sylvester’s method included 16 breathing-in and breathing-out repetitions in a minute.

As for the latter, Nielsen would turn over the victim on the side and bend their elbows. The head rests on the victim’s palm. Nielsen focused on compressing the patient’s back to release the air and pulling the elbows and torso to allow the air to go in. Nielsen’s method cycle also included 16 repetitions per minute.

Introducing Defibrillation

Incorporating defibrillation during the rescuing technique dates back to the 18th century when physicians experimented with the effect on animals. However, the first records of defibrillation were published by Beck in 1947, but on an open heart. Later, in 1957, Kouwenhoven explained that defibrillation shows positive results on closed chests as well.

The first portable or mobile AED was invented in 1965 by Peter Pantridge and weighed 70 kg. It operated on car batteries, which explains the weight.

Founders of the CPR Method

The renowned resuscitation pioneer doctors Kouwenhoven, Safar, and Jude suggested the combination of mouth-to-mouth breathing and chest compressions. Their idea was to create a rescue method—cardiopulmonary resuscitation—which we now refer to as CPR.

The AHA immediately started a teaching program to inform other doctors about this closed-chest cardiac resuscitation and adopt it as a principal rescue technique. Additionally, to support the move, doctors Safar, Elam, and Gordon, along with the toymaker Åsmund Lærdal, created the first life-size training manikin. Their efforts have helped over 400 million people learn how to act on the spot in case of an emergency.

The Modern CPR

The modern CPR, or the technique used in the 90s, is similar to the one we use today. The CPR technique used in the 90s till the early 2000s required a compression-ventilation ratio of 15:2. Additionally, AED for bystanders was introduced in the rescue technique during the 1990s.

However, the cycle of 15 chest compressions and 2 rescue breaths proved ineffective. As a result, the AHA made new changes in CPR.

The new guidelines introduced the chain of survival with 4 links or steps:

      1. Call 911
      2. Immediately provide CPR
      3. Use AED
      4. Provide advanced CPR in the hospital.

    Additionally, the compression-ventilation ratio changed to 30:2.

    CPR of the 2010s

    The CPR guidelines of the 2010s were simplified to make the technique more effective and provide better conditions for the rescuer. Firstly, there was an addition to the links in the chain of survival – “5. Post-cardiac arrest care.”

    The cycle of 30:2 remained the same, except there were changes in the pace of compressions. It was established that 100-120 works for all victims regardless of age.

    The technique proved highly effective, and there was no need for changes in the guidelines until the AHA had to alter them due to COVID-19.

    CPR During the Pandemic

    With the restrictions and preventive measures during the pandemic, the number of sudden cardiac arrests outside the hospital increased by 38%. Also, the survival rate of sudden cardiac arrest was reduced from 15% to 10%. The reason for the decrease in helping victims of sudden cardiac arrest was the fear of COVID-19. Many bystanders would avoid getting too close to the victim, and the best help they could offer was to call 911.

    However, it was impossible to help everyone, especially given the increased number of OHCA cases. Therefore, the AHA customized the guidelines according to the new conditions directed by the pandemic.

    Therefore, in 10 seconds, the bystander had to establish if the person needed help from a safe distance by checking signs of movement on the chest, shouting their name to see if the person would respond, and pinching the back of the hand. If the person showed no signs of life, they were required to call 911 immediately.

    Otherwise, to prevent direct contact with the victim, the bystander had to put a piece of cloth on the mouth. The person had to use the compressions only.

    Conclusion: CPR Today

    The CPR today remains 5 cycles of 30 compressions combined with 2 rescue breaths. The bystander has to call 911 immediately and then proceed with CPR and help the victim.

    If you want to learn more about CPR and how to provide help to a victim of cardiac arrest, we recommend getting certified at one of the training centers in Louisville. You get to learn the basics, practice your skills on a manikin, and receive the CPR certification.