Administration and Leadership, Airway & Respiratory, Cardiac & Resuscitation

CPR Evolves Through Time

Issue 11 and Volume 36.

EMS has come a long way when it comes to reinstating spontaneous breathing and circulation of patients preordained for celestial earthly emancipation. I remember a time when CPR stood for Can’t Possibly Recover. Not that your first compression has, or ever had, a favorable prognosis for coffin evasion by your patient, but I can honestly say my cardiac arrest patients are beating off angels more than ever before since the implementation of the 2010 AHA Guidelines—despite my paramedic arrogance.

Any patient requiring CPR today should consider themselves lucky compared with those in the early days. OK, not lucky, but certainly more fortunate than those poor souls who lost pulses when mankind seriously lacked a basic knowledge of human anatomy, pressure variances and, more importantly, any form of toothbrush/Tic Tac technology. To gain an appreciation of how far we have come, let’s go back to before the Bee Gees discovered singing to the time of BTSOOM (Beats the Sh*t Out of Me) medicine.

The Early Ages—Heat method:
People noticed that once the body became lifeless, it also became cold. Surely by placing warm ashes on top of the body, the heat would restore life. Although illogical, it did lead to the established profession of cremation.

The Later, but Still Early Ages—Flagellation method: Would-be rescuers would whip the deceased in the hope of inspiring them to breathe again. A similar form of painful resuscitation is practiced today by concurrently hitting the patient with both the ED and ambulance bill.

1530—Bellows method: Victims had hot air or smoke from the bellows of a fireplace forcefully blown into their sealed mouth—also known as a BBQ BVM (bellows vomit metabolizer).

1711—Fumigation method: This process involved propelling tobacco smoke up the lifeless victim’s rectum. Unfortunately, the victim would often go on to develop COPD (colon obstructive peristalsis disease). Not surprisingly, this directional process of blowing smoke is still used today by some QA and operational managers.

1773–Barrel method: Place the victim over a wine barrel and roll the barrel back and forth to force air in and out of the victim’s chest cavity while allowing the wine to breathe before consumption.

1803—Russian method: This ridiculous method of resuscitation involved reducing the victim’s core temperature by placing the body under layers of snow and ice. This has got to be the stupidest concept regarding brain-saving resuscitation ever, huh?

1812—Running horse method:
Drowning victims were straddled onto a horse while the horse galloped around in a circle. The bouncing of the body on the horse provided an alternate compression and relaxation of the thorax. Unfortunately, side effects included a bad case of the trots for the victim.

1892—Tongue stretching: French rescuers would hold the victim’s mouth open while pulling the tongue outwardly in a forceful and rhythmic manner. So impressed were the French by this method that this became their primary means of kissing.

Other compassionate methods of resuscitation included hanging people upside down, tickling their throat with a feather, waving ammonia under the victim’s nose and playing the Bee Gees “Saturday Night Fever” album backward.

Thank goodness the 1950s and ’60s gave us James Elam, Peter Safar, Frank Pantridge and cardiologist Leonard Scherlis—Bee Gee fans all. They and others I’ve never bothered to research truly got the ball rolling.

Along the way, Resusci Anne has received a lot of protocol tweaking, including some dyslexic prioritizing of the ABCs (now CABs). As a yearling medic, I remember a time when egocentric CPR instructors stood over me while I tried to produce the perfect CPR strip as it printed its way out of Resusci Anne’s side. My lips would be bruised from all the flawless rescue breathing deemed necessary.

In reality, however, my CPR skills on scenes consisted of me pointing to an EMT and saying, “start CPR.” I was a paramedic after all, and CPR was an inconvenient distraction from getting the tube, pushing the drugs, yelling “clear” and marveling at my ECG-interpreting skills. For each ALS skill I gained, I lost one BLS skill.

As the 2010 AHA and International Liaison Committee on Resuscitation continues to struggle in their attempt to rewire the old guard of EMS toward performing high-quality, continuous CPR—in conjunction with electricity (without excessive ventilation), less emphasis on advanced airways (gasp), ALS drugs and post-resuscitative oxygen—let’s keep an open mind and assume they’re not just blowing fumigation resuscitation up our smoke-free environment.

Until next time, pump hard, pump often and pump rhythmically. JEMS

This article originally appeared in November 2011 JEMS as “Bee Gee Resuscitation: Keep patients stayin’ alive.”