CPR's 50th anniversary
This week, the American Heart Association (AHA) looked back on the 50 years of cardio-pulmonary resuscitation (CPR). This really is the anniversary of the modern program that the American Heart Association endorsed and started back in 1960 for physicians, a forerunner for their public campaign.
Attempts to save lives throughout history
On the AHA's website, you can find a timeline of the history of attempts at resuscitation dating back to the Age of Enlightenment in the 18th century. The development of the Society for the Recovery of Drowned Persons was an attempt to deal with sudden unexpected deaths. There was a recognition that mouth-to-mouth resuscitation could save a drowning victim. Several of their recommended steps of doing mouth-to-mouth such as removing swallowed water by positioning the head lower than the feet and blowing into the persons nose and mouth are still practiced today.
In the late 1800s and early 1900s, there were reports of successful resuscitations using some external chest compressions (Drs. Fredrich Maass and George Crile). However, it wasn’t until the late 1950s and early 1960s that scientific evidence showed exhaled air in mouth-to-mouth was sufficient to sustain good enough oxygen levels needed to breathe (Drs. James Elam and Peter Safar). In addition, if coupled with external chest compressions, which created an adequate blood pressure, this technique was sufficient to resuscitate individuals thus allowing some victims to survive (Drs. William Kouwenhoven, Guy Knickerbocker and James Jude). This coupling of mouth-to-mouth and chest compression was presented at the annual Maryland Medical Society in 1960. It became what we know as CPR today.
In 1963, the AHA formally endorsed CPR, along with the American Red Cross, which helped to establish standardized training and protocols. It’s now estimated that about 12 million people, both healthcare professionals and lay people, yearly are trained in CPR.
How CPR saves lives
According to the AHA, about 300,000 people a year have sudden cardiac arrest (SCA). This is an electrical malfunction that causes the heart to beat chaotically or suddenly stop beating. Often, these victims have no prior history of cardiac problems. It is different than a heart attack, which is caused by a blockage in an artery that then leads to dying heart muscle; however, large heart attacks can also cause sudden cardiac arrest. The majority of cases of SCA occur outside the hospital, with the grim statistics that only 8% of victims survive. This may be attributable to the fact that less than 1/3 of these victims receive bystander CPR, which can more than double your chances for survival.
Why people are reluctant to do bystander CPR
Growing evidence shows that even if a person is trained in CPR, there seems to be a reluctance to perform it in an emergency situation on strangers. Often, bystanders will say they were unsure or intimidated by the ratio of the number breaths to number of compressions. Many people are not willing to give mouth to mouth to a stranger, thus are less likely to do CPR at all. Many recent studies have found eliminating mouth to mouth dramatically increases a bystander’s chance of doing CPR. However, more importantly, it is effective and still increases survival of the victim. This fall, the Journal of the American Medical Association published a study, which corroborated older studies and found that hands-only CPR increases survival up to 34%, even better than conventional CPR. This is probably because stopping the compressions to blow into someone’s mouth momentarily stops the blood from pumping up to the brain. Therefore, it is actually better to just keep blood flowing until help arrives. The study also cited that the percentage of people willing to do hands-only CPR increased from 28% to 40%.
New 2010 AHA guidelines for CPR
The AHA decided to revise their guidelines acknowledging the research that showed bystanders were more likely to perform Compression-only or Hands-only CPR on a stranger and, in this setting, it actually works better than conventional CPR. It is now the mainstay of life support advocated by the AHA for bystanders witnessing a cardiac arrest. It doesn’t even really require training. They advocate that anyone can and should do this.
According to the AHA, the main goal is compressing the chest hard and fast in the center. It requires depressing it about 2 inches deep at a rate of about 100 beats a min. They even state the Bee Gee’s song “Staying Alive” has a beat of about 100 per minute, so they recommend humming the song in your head can help.
As an ER doctor, I advocate that everyone should take first aid and a lifesaving CPR course, but I applaud this new initiative. Seconds count when you are saving a life and inaction can be fatal. Even if you haven’t taken a course, I implore that if someone collapses and has an arrest near you, after you call 911, roll up your sleeves and start humming that old disco tune while pushing on their chest. You will certainly increase their chances of “Staying Alive”!