ASHI and MEDIC First Aid Blog

June 4, 2019

CPR and AED for Cardiac Arrest: Understanding Fact, Fiction, and Evolution

By guest blogger Bill Rowe, Director of Content Development

It’s hard to believe I am going on my 41st year of being involved in resuscitation education. In many cases things have stayed the same (push and blow), in some they have changed drastically (AEDs!), and some have even gone and come back with a vengeance (high-quality CPR skills).

It seems like there is more going on in resuscitation today than at any other time since its inception. Since we are celebrating National CPR and AED Awareness Week, I thought a review on all things CPR and AED, with a bunch of fun links, would be helpful to stimulate some discussion and perhaps reinvigorate our efforts to make a difference. 

Cardiopulmonary Resuscitation

The history of modern CPR is remarkable and I can’t even begin to scratch the surface in a blog article. A special shout out goes to Dr. Mickey Eisenberg and his book Life in the Balance: Emergency Medicine and the Quest to Reverse Sudden Death, the most comprehensive history on resuscitation I have found.

Rescue breaths and chest compressions arose on separate paths, each with their own distinctive histories.

The earliest reference to rescue breaths seems to be in the old testament of the Christian Bible as the prophet Elisha, “…put his mouth on his mouth, his eyes on his eyes and his hands upon his hands, he leaned over him and the boy’s body grew warm…”, and a young boy who had died “…opened his eyes.”

In the 1700s, the Society for the Recovery of Persons Apparently Drowned, known today as the Royal Humane Society, further pioneered the efforts of artificial respiration for victims of drowning in England. One of the more obscure bits of information lists them as an early pioneer of using fireplace bellows to blow smoke into a victim’s rectum to stimulate breathing.

Mouth-to-mouth rescue breaths, as a common method of artificial respiration, lost ground in the 1800s as the much more good-mannered and sanitary “manual” methods of artificial respiration took hold.

It wasn’t until the 1950s, and the relentless advocacy of Dr. James Elam, that mouth-to-mouth rescue breathing was proven (with the help of a giant pulse oximeter) to be far superior to the manual methods and the obvious choice for artificial respiration.

The best story to reflect the early history of chest compressions comes from Johns Hopkins University in the 1950s where Dr. James Jude, and engineers Guy Knickerbocker and William Kouwenhoven did pioneering research on both external chest compressions and defibrillation. Click here to learn how a dog, a bulky old defibrillator on wheels, and a rickety old hospital elevator helped to establish the concept of using repetitive compression of the chest to artificially create forward blood flow.

Finally, in the 1960s, Dr. Peter Safar, often referred to as the “father of modern CPR”, is credited with leading the effort to combine mouth-to-mouth rescue breaths with external chest compressions into the current form of CPR. 

Early Defibrillation

The earlier you defibrillate the greater the chance for surviving sudden cardiac arrest.

As Stan Lee would say, “’nuff said.”

CPR buys time for defibrillation. We can surely get into the weeds on details, but at its core, the relationship between CPR and defibrillation is as absolute as it gets. In the early days (1960s-1970s), it took a long time to get a defibrillator to someone in cardiac arrest outside of a hospital. About the only chance for survival was from immediate activation of EMS and CPR by a bystander, followed by defibrillation from responding EMS personnel. Not great, but what else was there?

I’ll take “What are AEDs?"  for $500, Alex...

In the late 1970s, Dr. Arch Diack, a cardiac surgeon in Portland, Oregon led a team of physicians and engineers to develop the Heart-Aid Automatic Cardiac Resuscitator, essentially the first commercial AED. For the first time, bystanders at cardiac arrest emergencies could provide defibrillation, prior to the arrival of EMS providers.

Since then, AEDs have morphed into the portable, user-friendly versions we have today. Laws and regulations have been developed to legally protect users and require AEDs where sudden cardiac arrests may occur.

Compression-only CPR

We don’t like giving rescue breaths to someone we think is dead. It has been a significant barrier to bystander involvement in a sudden cardiac arrest emergency. Also, CPR gets pretty complicated when you start adding all that stuff about head tilts, chin lifts, too much air, too little air, ratios, and numbers.

As it turns out, when somebody experiences sudden cardiac arrest, forward blood movement in the body stops, trapping red blood cells and the oxygen they carry in the bloodstream. Just doing chest compressions can, for at least a few minutes, finish delivering that oxygen to the cells and keeping them alive.

How remarkable is it that, for sudden cardiac arrest, there is a simple “put your hands in the center of the chest, push hard, push fast, and keep pushing” alternative to traditional CPR?

Keep in mind that rescue breaths still play an important role, but the compression-only method is an effective option for the untrained masses and when giving rescue breaths is not possible or not desirable.

Readiness

Perhaps the most important evolution in resuscitation is the growing emphasis on readiness, commonly described as high-performance CPR. Simply put, how do we prepare ourselves to be ready at any given time to provide an effective emergency response to sudden cardiac arrest? EMS systems are already leading the way with a focus on maintaining quality CPR skills, efficient team-based approaches, and technology that provides immediate feedback on performance. Adoption of the high-performance concept is growing in bystander training.

The heart of readiness is the maintenance of psychomotor skills through ongoing hands-on skill practice. Skill quality matters. Most importantly, it is reflected in the increased chance for surviving cardiac arrest.

Initial training is essential to grasp concepts and details on skill performance, but readiness is primarily developed in shorter, more frequent, hands-on practices, especially scenario-based, simulated emergencies.

It’s common sense that just knowing about CPR is not good enough. It is a skill-based treatment that requires psychomotor skills. Beware of cognitive-only training, especially online, that claims to be as effective as training with hands-on skill practice. It is not.    

Survival Is Local

Finally, I would like to leave you with a concept that helps to emphasize how important your role is as an emergency care educator.

I am a firm believer that survival from sudden cardiac arrest is influenced mostly at the local level. All of the things presented in this article have a common thread. They need a champion to take them from ideas to reality. That’s you.

Individually, you probably don’t have much influence on improving survival on a national scale, but you may have enormous influence on your workplace, your customer’s workplace, your community, your home, or your house of worship.

You can provide initial training, set up an AED program, and conduct ongoing short practices to maintain readiness, all to improve the ability to survive sudden cardiac arrest within a small group.

We Can Help

HSI has developed a number of training programs related to CPR and the use of an AED. Our core ASHI and MEDIC First Aid CPR, AED, and first aid training programs are packed with features to help you provide a comprehensive CPR and AED training solution for those in need. Our specialty program on High-Performance CPR, allows you to bring high-performance CPR concepts to the lay provider level. Whatever your needs are: training programs, AED trainers, or manikins, we can help.   

 

   

 

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