The History of Resuscitation

W. Lawrence Daniels, MS, MSN, CPNP, NREMT-P

Hampton University

800 B.C. Elijah

The first apparent attempt at resuscitation was Elijahs mouth to mouth revival. (Bible, 2 Kings, iv, 34.)
And he went up, and lay upon the child, and put his mouth upon his mouth, and his eyes upon his eyes, and his hands upon his hands; and he stretched himself upon the child; and the flesh of the child waxed warm.

Early Ages Heat Method

Warm ashes, hot water, burning dried animal excreta anything hot applied to the abdomen of victim was thought to restore heat and life to the cold body.

Early Ages Flagellation Method

If in apparent deep sleep, pain caused by whipping with stinging nettles, striking with hands or wet cloths was helpful in reviving victims.

1530 Bellows Method

Fireplace bellows were first used by the Swiss physician Paracelsus to introduce air into lungs. Variations were used in Europe for 300 years. Unfortunately, not many people carried fireplace bellows with them, but the success of this procedure motivated various manufacturers to design and manufacture Bag-Valve-Mask Resuscitators.

1530 Bellows Method

However, in those days, the medical authorities were not aware of the anatomy of the respiratory system and did not appreciate the need to extend the victim's neck in order to obtain a clear airway. In 1829, Leroy d'Etiolles demonstrated that over distension of the lungs by bellows could kill an animal, so this practice was discontinued.

Early 18th Century

External chest compression was first described by John Howard.

1711 Fumigation Method

Smoke was blown into an animal bladder, then into the victims rectum. Used successfully by the North American Indians and the American colonists. The technique was introduced in England in 1767. This practice was abandoned in 1811 after research by Benjamin Brodie when he demonstrated that four ounces of tobacco would kill a dog and one ounce would kill a cat.

1767 - Dutch Society for Recovery of Drowned Persons

The Dutch recommendations included:
Warming the victim (which sometimes required transporting the body to a different location) by lighting afire near the victim, burying him in warm sand, placing the body in a warm bath, or placing in a bed with one or two volunteers; Removing swallowed or aspirated water by positioning the victim head lower than his feet and applying manual pressure to the abdomen, vomiting was induced by tickling the back of the throat with a feather; Stimulation of the victim, especially the lungs, stomach and intestines by such means as rectal fumigation with tobacco smoke, or the use of strong odours; Restoring breathing with a bellows; Bloodletting. These and other methods had been applied for years as documented in the report of Anne Green's hanging, resuscitation and recovery in 1650. Other methods included physical and tactile stimulation in an attempt to "wake up" the victim. Yelling, slapping, even whipping were used to attempt to resuscitate.

1770 Inversion Method

Methods were developed in the 1700's in response to the leading cause of sudden death of that time, drowning. Inversion was originally practiced in Egypt almost 3,500 years before and it again became popular in Europe. This method involved hanging the victim by his feet, with chest pressure to aid in expiration and pressure release to aid inspiration.

1774 Royal Humane Society In response to the increasing numbers of drowning during this time period, societies were formed to organize efforts in resuscitation. England's Royal Humane Society was founded in 1774. Although it was the most famous, it was not the first.

1773 Barrel Method

Barrel movement back caused compression of the chest for expiration. Barrel movement forward released pressure for inspiration. Used before 1767, this technique may still be seen along waterfronts (1963).

1788
"An Essay on the Recovery of the Apparently Dead" Conclusion: the most important factor in success leading to 'recovery of the apparently dead, is the length of time that elapses before the proper remedies can be applied

1803 Russian Method

Successful resuscitation may be achieved by burial in the snow. A modification was to bury the victim upright with head and chest exposed dashing water in his face. This concept involved reducing the body's metabolism by freezing the body under a layer of snow and ice. Unfortunately, what the medical authorities did not realize at the time, was that the most critical organ which needed to be frozen in order to accomplish a reduction of the body's metabolism was the brain.

1812 Trotting Horse Method

The body is alternately compressed and released. Compression forces air out and release allows air to enter the lungs. This method was used on European inland waterways in drowning cases.

1815 Trotting Horse Method

In 1812 Lifeguards were equipped with a horse which was tied to the Lifeguard station. When a victim was rescued and removed from the water, the Lifeguard would hoist the victim onto his horse and run the horse up and down the beach. This resulted in an alternate compression and relaxation of the chest cavity as a result of the bouncing of the body on the horse. This procedure as banned across the United States in 1815 as a result of complaints by "Citizens for Clean Beaches".

1829 LeRoy Method

This was the first use of the supine position. Pressure was applied over the chest and abdomen for expiration. The release of pressure caused inspiration.

1831 Dalrymple Method

A swath of cloth around the chest was pulled by two rescuers. This compression forced air from the lungs. The chest expanded when the cloth was released for inspiration.

1856 Marshall Hall Method

In this method the chest was elevated with the patient in the supine position. The victim was pulled up onto his side momentarily, then rolled back. Pressure on the back expelled air. The pressure was released when the victim was pulled onto his side for inspiration.

1856 Hall Fights Tradition

As late as 1856, manual ventilation was given low priority, concentration was on maintaining body heat. These were the same recommendations as provided by the Dutch nearly 100 years earlier. A significant change in priorities occurred when Marshall Hall challenged the conventional wisdom of the Society. His contention that time was lost transporting the victim; that the restoration of warmth without some type of ventilation was detrimental; that fresh air was beneficial; and that if left in the supine position, the victim's tongue would fallback and occlude the airway. Because the bellows were no longer an option, Marshall Hall developed a manual method in which the victim was rolled from stomach to side 16 times a minute. In addition, pressure was applied to the victim's back while the victim was prone (expiratory phase). Tidal volumes of 300 ml to 500 ml were achieved and soon became adopted by the Royal Humane Society.

1858 - Janos Balassa (1814-1868)

Successfully performed cricothyrotomy followed by chest compressions during a case of asphyxia from laryngitis.

1858 External Massage

First paper on external heart massage

1861 Silvester Method

Known as Chest Pressure Arm lift, the victim was placed on his back. His arms were held at the wrist. For expiration his arms were folded over his chest and pressure was applied. For inspiration, the rescuer leaned back pulling the arms up and back. The tongue was held to maintain the airway. The American Red Cross taught this technique until the 1974 revision of their first aid courses.

1865
First urban ambulance service (Cincinnati)

1871 Howard Method

The rescuer straddled the victim. Expiration was induced by exerting pressure on the upper abdomen and lower chest. Inspiration occurred when pressure was released.

1886 J. B. Francis Method

Raising the victim with a board under the lower back induced expiration. Lowering caused inspiration. This method proved of little value since it sometimes caused spinal injury.

1892 - Tongue Stretching

Other methods still used included stretching the rectum, rubbing the body, tickling the throat with a feather, waving strong salts, such as ammonia, under the victim's nose. In 1892, French authors recommended tongue stretching. This procedure was described as holding the victim's mouth open while pulling the tongue forcefully and rhythmically.

1894 Prochownick Method

A newborn would be inverted. Squeezing the chest and the force of gravity would induce expiration. Release allowed the lungs to fill.

Early 20th Century Crile described an experimental method in animals combining chest compression, artificial respiration, and parenteral adrenaline.

1903 Schafer Method

Also called the Schafer Prone Pressure Method, the rescuer would press on the back of the victim forcing the abdominal organs against the diaphragm. This compressed the lungs for expiration. Release caused inspiration. The American Red Cross taught this technique until the 1974 revision of their first aid courses.

1916 Acklen Method

This device was sealed to the lower thorax and upper abdomen. Decreased pressure was induced under the device when it was lifted causing inspiration. Expiration was passive when pressure was released.

1918 Stewart Method

This is the first air-tight cabinet method. Tight seal allowed bellows to induce positive and negative pressure on the abdomen. This inflated and then deflated the lungs. This is the forerunner of the iron lung.

1926 Eisenmenger Method

Air from an electrically driven pump produced pressure and negative pressure to induce breathing.

Rudolf Eisenmenger
Rudolf Eisenmenger (1871-1946) was the first to propose active compression-decompression cardiopulmonary resuscitation (ACD-CPR) and a device to do so, which was later named Biomotor. Eisenmenger worked on and published information about ACD-CPR from 1903 until 1942. He thus upheld external cardiac resuscitation in the "dark age" between World Wars I and II. Although the device was used as a ventilator in several hospitals, few contemporaries took the idea of ACD-CPR seriously.

1931 Pole Top Method

The Oesterreich Method was used by linemen suffering electric shock. The abdomen was compressed inward and upward for expiration. Release allowed inspiration.

1932 Holger-Nielson Method

With this back-pressure arm-lift method, the rescuer pushes down on the victims back for expiration. Rocking back while lifting the victims arms towards the rescuer causes inspiration. The American Red Cross taught this technique until the 1974 revision of their first aid courses.

1936
Study published showing that exhaled air could be used for artificial ventilation

1940s Iron Lung

1956
Zoll published his accounts of defibrillation. Study showing effectiveness of mouthto-mouth ventilation in adults is published.

1957

Baltimore City Hospital, Department of Anesthesiology, Resuscitation Experiment Volunteer Felix S. Teich, Resident in Surgury

1958 Mouth to Mouth Resuscitation

Safer and Elam formally presented mouth-to-mouth ventilation. During World War II, this procedure was advocated within the United States military services. In 1950, organizations like the American Red Cross began an aggressive education campaign in order to educate the American public. In the 1960's this training was expanded by which Lifeguard Personnel were instructed in this procedure by performing mouthto-mouth resuscitation in the water using Rescue buoys, paddleboards, and boats and canoes as flotation supports while performing this procedure in the water.

1960 Cardiopulmonary Resuscitation

Kouwenhoven, Jude, and Knickerbocker rediscovered external chest compression while testing defibrillation on an animal model of ventricular fibrillation. The paper describing this discovery (of chest compressions used to resuscitate) is widely attributed as being the usher of the modern era of cardiopulmonary resuscitation (CPR).

1963 First Save

First pre-hospital cardiac arrest victim saved in-field by what was to be called CPR

1970
First paramedic programs started in Seattle, Portland, Los Angeles, and Columbus

1973 - CPR for the People During the Vietnam War the US army introduced CPR to the people for the first time. Then, in 1973 the American Red Cross and the American Heart Association (AHA) began a big campaign to teach the American population this method.

1990
American Heart Association proposes "Chain of Survival
Early access to EMS/911 Early bystander CPR Early defibrillation Early advanced life support

1996 Rapid Zap

Early Defibrillation position paper issued by the American Heart Association.

1997+
Experiments in reducing brain damage in the field by cryogenic preservation: i.e. liquid nitrogen helmet applied to head until blood flow is reestablished.