The History of CPR

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.

This blog entry is based on content from a podcast interview with Karl Kern, MD, Mary Beth Mancini, RN, PhD, and Raina Merchant, MD, MSHP, titled AHA’s History of CPR.

Dr. Raina Merchant: Can you tell us a little bit more about what CPR actually is?

Dr. Karl Kern: CPR is simple a technique to provide blood flow to the organs of the body when the heart’s not doing its job. It often gets confused with a heart attack. A heart attack can cause cardiac arrest, but it’s actually the step where the heart no longer is pumping forward blood flow. That can happen either because it stops beating. It has no heartbeats that are effective, or it can actually go too fast or quiver in what’s called ventricular fibrillation. The result is the same. No flow and the organs, particularly the brain, begin to suffer right away. One falls unconscious and if not treated, it’s clearly a mechanism that will lead to ultimate death.

Dr. Beth Mancini: When we think about cardiopulmonary resuscitation, we often think about the American Heart Association. Perhaps you can tell us a little bit about the history.

Dr. Karl Kern: The American Heart Association is well known for its involvement with cardiopulmonary resuscitation. CPR really had its beginnings in the late ’50s, early ’60s. Prior to that time, if you had heart stoppage or cardiac arrest, the only real treatment was to open up your chest, put your hand in there, and actually squeeze the heart directly to create some blood flow. Obviously that has limited applicability. So in the late ’50s, early ’60s, the discovery was made that by pushing on the chest, you could create some flow. It’s not a normal amount of flow. It’s not what you’re used to, but it’s enough to keep the most important organs of the body alive, particularly the brain and the heart so that the heart can respond to further treatment and begin to beat on its own.

The real excitement was really started in Baltimore at Johns Hopkins where, during an experiment to try to shock the heart, they noticed when they pushed hard to make sure the paddle had good contact, they could see a little bump in the aortic pressure. When they pushed rhythmically, they could actually produce blood flow that would, again, help the heart, help the brain, and keep those two vital organs viable.

It began with compressions and then actually people began to think, “Well, we need to replenish the oxygen.” So the concept of ventilation interposed with the compressions was introduced. Again, for the lay public, mouth-to-mouth breathing. The two were married for several decades as the way to do CPR. The problem was that in some communities the citizens were simply not willing to do that form of rescue. Whether it was fear for disease, transmission, or whatever, certainly the aesthetics of mouth-to-mouth contact with a stranger was an impediment. So a number of centers, including where I am at the University of Arizona, we began to wonder, “Well, how important is the breathing part? What’s the key component to save a life, even if you have some price to pay?” So we began to explore compressions only, or hands-only as it’s now called by the American Heart Association. This is not true for children whose arrest is often first precipitated by respiratory problem, but for witnessed adult who collapses in front of you, that compressions only was very helpful and probably enough for those first 10 to 15 minutes. And then clearly as sooner or later you must do some breathing and replenish the oxygen.