Things You Haven't Heard About the History of CPR

Like the history of science, CPR have also undergone quite the journey before we found the best method to save people from cardiac and respiration accidents. Today we’re going back in time to learn about CPR’s progress over the years with Violin MD, Siobhan.

Hey guys, I'm Siobhan, a second-year medical resident. In the US and Europe combined about 2,000 people have a cardiac arrest outside of the hospital every single day. Most of the time it's witnessed by somebody and if that person goes over and starts chest compressions, then there's a way higher chance that the person's going to wake up without having any brain damage. But if chest compressions aren't started, then the brain doesn't get oxygen and it slowly starts to die before help can arrive. So by the end of this video, I want to convince each and every one of you that you can save someone's life, even if you're a kid.


You don't have to be a doctor or a nurse, you just have to call for help and start chest compressions. CPR is a really simple,amazing technique, but it actually took doctors a really long time to discover it. Their first goal was to figure out: How can we get people to start breathing again? Get air in and out.And so back in the 1500s, they came up with the bellows method. They took an actual bellow from a fireplace and pushed air in and out of a patient and this became the standard for the next 300 years.


They also came up with other methods like rolling a patient along their back or using the movement of a galloping horse to help move the air. In 1859 an English surgeon called Dr. Henry Sylvester came up with a new technique and this one's called the chest pressure arm lift method, which was still just focusing on breathing. But this became the new standard across the world and it was actually taught in the St. John's first aid manual until 1972.


Meanwhile, there was a group of doctors who were interested in how to get the heart to pump and actually circulate the blood, rather than just focusing on breathing. Although they had some success, the medical community wasn't all that excited about it. But if you were in the hospital at the time, the standard of care was to crack open the chest and actually massage the heart.


We actually still do that today in rare circumstances and they do it in cardiac surgery sometimes. Obviously that's not something that you can do on the street or outside the hospital when someone first has a cardiac arrest. So one of you guys from the community sent me a video published by the Canadian government back in the 1920s and it showed what they were telling the public to do for resuscitation. I've never seen anything like this, so thank you for sending to me. Really cool!


So the details of prone pressure method - prone is on your belly. Patient on the belly, arms extended, face to one side. Which makes sense in case you know, someone were to vomit and then they won't aspirate it, they're getting them in that position. Kneel straddling the patient's hips. That's a little personal. Palms on the small of the back, little finger touching the lowest rib, so that's really pushing on the lower back. Maybe to push up the diaphragm and get the person to breathe out.Very different than what we do today. Arms straight, swinging forward, bringing weight of the body slowly to bear. We actually do that as well, arm straight and lean forward with CPR. Swing backward and rest, then repeat deliberately. Time with your breathing. Assistant administers ammonia so the timing with the breathing, they're still really focused on the lungs and not on the heart.


You heard of smelling salts, like what they'll give to wake someone up if they fainted. The idea is that
It's a caustic smell and it'll irritate the lungs and trigger you to take a breath in and get the oxygen moving.
So if someone's had a cardiac arrest, probably not really gonna be helping them at this point. Anyway, very cool to see that this was the standard of care in 1920s. Do not stop or interrupt resuscitation until patient breathes or stiffening of the body sets in, so rigor mortis is what they're talking about and the patient's officially passed away. Do not give up under 4 hours. That's an incredibly long time. Especially with the method that they are using, when you're not actually circulating the blood. There's no way after even a short period of time that that patient would survive, their heart stopped.


It may surprise you it wasn't until 1933 at Johns Hopkins University that some doctors and engineers got together and figured out that giving chest compressions as well as some shocks to the heart would help revive somebody. And then it wasn't until 30 years after that, in 1960 that they put all of this together: Chest compressions + mouth-to-mouth resuscitation for the breathing together was the most successful and it was called cardiopulmonary resuscitation or CPR as we know it today.


So CPR gained massive popularity and it was taught all around the world. And then later on we started having AEDs, so the Automatic Electrical Defibrillators that were found in public locations. Take a look around, you'll see them everywhere once you start looking for them. Those would actually give instructions to the public and they'll administer electrical shocks when it's needed outside the hospital, another life-saving move.


I think there's a lot of confusion or fear around mouth-to-mouth breathing, because if you see a stranger down on the ground, you don't really want to touch your mouth to theirs and then someone won't evenstart chest compressions as a result. In 2008, the American Heart Association decided to teach hands-only CPR, basically if you see someone on the ground and they don't have a pulse: Start compressions, because at the end of the day chest compressions are the most important part.
Like if you just do this on your chest, you're moving air. So there is still some oxygen that circulated, even if you're just doing chest compressions.


Today there are these supercool machines that I actually haven't even seen yet and they can be strapped around a person and just be administering chest compressions on their own, so people don't actually have to be doing chest compressions, it's a machine. Now that would be amazing ,because once you've done CPR for a long time, my wrists really start to hurt.


So the most important part of this video: What should you do if you see a person that's collapsed onto the ground?
1. Call for help. Whether that's 911 or 112, wherever you are in the world and
tell them what's going on.
2. Second thing is to be checking for a pulse, see if they are responsive and then if not: Start chest compressions!
3. Most important thing, continue doing that until help arrives.


I recommend actually taking an official CPR course, so that you're certified and you feel confident to know what you're doing, but here are some general tips. So if it happens to you tomorrow before you've done a course then you know what to do.

• So you overlap your hands and then you lean forward with your arms locked and use your body weight to apply pressure to the chest.
• The goal is to compress the chest about two inches. It actually needs to be deep enough that you're able to push down on the heart, so that it can pump it.
• Then you want to compress at a rate of about 100 to 120 beats per minute. And the classic song that everyone tells you to remember is Stayin' Alive, because it's around 100 beats per minute.
• Because the danger or the thing that most people do is they go too quickly, because they have a lot of adrenaline. That doesn't leave time for the heart to fill back up with blood. And actually in countries where they do this and train everybody, when there's a cardiac arrest people do CPR about 75% of the time, which is really good compared to other countries where it's only about 20 to 40 percent of the time.

I really hope that you learned something and that you also get a sense of how
innovation and creativity happens over time in medicine.


Crazy History of CPR: Real Doctor Explains CPR (ft. Violin MD)
By: Violin MD
Retrieved from: https://www.youtube.com/watch?v=kRYCaU-nHrk