Modern CPR, the combination of chest compressions and rescue breaths, coalesced around 1960 through work by Kouwenhoven, Jude, and Knickerbocker (Johns Hopkins), building on earlier ventilation research by Safar and colleagues.
The American Heart Association (AHA ) in 1963 establshed it as the standard for treating cardiac arrest
Earlier resuscitation techniques existed, but none were as effective as the combined method introduced in 1960.
Cardiopulmonary resuscitation (CPR) is a life-saving technique to restore breathing and circulation to individuals who have experienced cardiac arrest or other medical emergencies. While the modern version of CPR has been around for over 50 years, artificially inducing circulation and respiration dates back to ancient times. In this blog post, we'll explore the fascinating history of CPR, from its earliest iterations to the modern technique used today for successful resuscitation.
What are the origins of artificial respiration and CPR techniques?
The earliest recorded instances of artificial respiration date back to ancient Greece and Rome. In the first century A.D., the Greek physician Galen described a method of resuscitating drowned victims by blowing air into their lungs through a reed. This technique was later refined by Roman physicians, who added abdominal pressure to force air into the lungs.
Over the next few centuries, various methods of artificial respiration were developed, including the use of bellows and the manual compression of the chest. However, these methods were often ineffective, and many individuals who experienced cardiac arrest or respiratory failure died.
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The concept of resuscitation dates back to 1740, when the Paris Academy of Sciences recommended mouth-to-mouth resuscitation for drowning victims. The modern development of cardiopulmonary resuscitation (CPR) began in the late 19th century. In 1891, German surgeon Dr. Friedrich Maass performed the first documented chest compressions on humans. In the early 1900s, Dr. George Crile conducted experiments showing that external chest compressions could restore circulation, and by 1903, he reported the first successful human resuscitation using this method.
During the 1930s, Holger Nielsen introduced the prone back-pressure/arm-lift technique, which became widely used through World War II despite its limitations—it required two rescuers and often proved ineffective. Meanwhile, in the 1940s, Dr. Claude Beck pioneered the use of defibrillation to restart the human heart, marking a separate but crucial milestone in resuscitation science. Continued research throughout the 1950s eventually led to the modern combination of chest compressions and rescue breaths that defines CPR today.
Modern CPR
In the 1960, a team of researchers led by Dr. James Jude, Dr. Peter Safar, and Dr. William Kouwenhoven developed the first modern technique for cardiopulmonary resuscitation. This technique, which combined chest compressions and artificial respiration, became known as CPR.
The development of CPR was a breakthrough in emergency medicine. Before its invention, there was no effective treatment for cardiac arrest, and the survival rate for individuals who experienced sudden cardiac arrest was less than 10%.
However, with the advent of CPR, survival rates began to improve dramatically. Overall U.S. out-of-hospital cardiac arrest (OHCA) survival is much lower (8–12% nationally). Early bystander CPR and rapid defibrillation can double or triple survival, and in selected cases with extremely early defibrillation survival has been reported as high as 50–75%.
Quick facts: overall OHCA survival in U.S. registries is roughly 8–12%; early bystander CPR and defibrillation substantially increase survival (often doubling or tripling the odds) and time to defibrillation remains the single strongest modifiable factor. (Based on CARES and AHA analyses.)
Who were the pioneers of modern CPR, and how did they develop the technique?
The pioneers of modern CPR were Dr. James Jude, Dr. Peter Safar, and Dr. William Kouwenhoven. Their groundbreaking work in the 1960 revolutionized the field of emergency medicine by introducing a combination of chest compressions and artificial respiration to treat cardiac arrest or respiratory failure.
Dr. Jude was the first to recognize that chest compressions alone were insufficient to restore circulation and breathing. So he began experimenting with various combinations of chest compressions and artificial respiration. After several years of research, he developed a technique that successfully restored circulation and breathing in patients who had experienced cardiac arrest or respiratory failure.
Dr. Safar then developed the first algorithms for administering CPR, which helped make the technique easier to learn and apply in an emergency setting. Finally, Dr. Kouwenhoven developed a "closed-chest cardiac massage technique," which proved more effective than open-chest techniques.
The combined contributions of these three pioneers revolutionized the field of emergency medicine and made CPR one of the essential life-saving techniques used today.
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What was the survival rate for cardiac arrest before modern CPR?
Before the invention of modern CPR, the survival rate for individuals who experienced sudden cardiac arrest was less than 10%. However, with the advent of CPR, survival rates improved dramatically. Overall U.S. out-of-hospital cardiac arrest (OHCA) survival is much lower (8–12% nationally). Early bystander CPR and rapid defibrillation can double or triple survival, and in selected cases with extremely early defibrillation survival has been reported as high as 50–75%.
Promotion of CPR Training
The American Heart Association formally endorsed CPR and created a CPR Committee in 1963, beginning organized guideline and training efforts. The AHA expanded public training through multiple programs; the Medic II citizen training program (Seattle, 1972) marked an important early mass-training event. The course included a combination of classroom instruction and hands-on training using mannequins. Leonard Cobb launched Medic II, the world's first mass citizen training in CPR in the United States.
In the 1980s, the American Heart Association launched a public awareness campaign to promote the importance of CPR training to improve the chances of survival. The "Friends and Family" campaign encouraged everyone to learn CPR to potentially save a loved one's life.
The Impact of CPR
The impact of CPR on emergency medicine cannot be overstated. In addition to improving survival rates for individuals who experience cardiac arrest, CPR has also been used to save the lives of individuals who experience drowning, drug overdoses, and other medical emergencies.
In addition to its life-saving benefits, CPR has also had a significant impact on public health education. In many countries, including the United States, CPR training is mandatory for certain professions, such as healthcare providers and emergency responders. In addition, many schools and community organizations also offer CPR training to the general public, which has helped to increase awareness and preparedness for medical emergencies.
Current CPR Techniques
The 30:2 compression-to-ventilation ratio was introduced in 2005. In 2010 the AHA emphasized C-A-B (compressions first) and promoted Hands-Only CPR for untrained bystanders, while trained rescuers were still taught 30:2.
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