Development of cardiopulmonary–cerebral resuscitation in the twentieth century

Abstract

Before the renaissance, death was to be accepted as an act of God. From then on, there was a will to attempt resuscitation. The ability to reverse coma-induced airway obstruction, apnea, and pulselessness began in response to accidents caused by general anesthesia in the late 1800s. Around 1900, knowledge existed about the majority of CPR steps. This knowledge, however, was then not assembled into an effective system because of lack of communication between laboratory researchers, clinicians, and rescuers. Open-chest CPR was effectively practiced in operating rooms during the first half of the 20th century. Anglo-American anesthesiologists co-pioneered trauma resuscitation during World War II. Modern cardiopulmonary–cerebral resuscitation (CPCR), which is now giving every person the ability to challenge death anywhere, has been developed since the 1950s. Through research in Baltimore, the chest-pressure and back-pressure arm-lift methods of artificial ventilation, taught for 100 years, were replaced by backward tilt of the head and direct mouth-to-mouth ventilation, and emergency artificial circulation by sternal compressions was rediscovered. Steps A–B–C of basic life-support were extended—to advanced and prolonged life-support. Anesthesiologists pioneered hospital ICUs almost simultaneously on three continents. In the 1960s and 1970s, several groups initiated CPR education research, the development of training aids, effective resuscitation delivery through emergency medical services (EMS) systems, and the multidisciplinary specialty of critical care medicine (CCM). Since the 1970s and 1980s, cerebral resuscitation potentials after prolonged cardiac arrest have been evaluated with ICU outcome models in large animals and in randomized clinical outcome studies. Pharmacologic strategies have given relatively disappointing results. Mechanism-oriented research escalated. Postarrest CBF promotion improved outcome in animals and patients. A breakthrough came in the 1980s and 1990s with the revival of research into therapeutic hypothermia. Mild resuscitative postarrest hypothermia (which is simple and safe) showed a breakthrough effect, extending the normothermic arrest reversibility limit from 5 to 10 min no-flow. Clinical trials of mild hypothermia are being reported now, with positive results. Animal research has begun into “suspended animation for delayed resuscitation” for temporarily unresuscitable cardiac arrest. Education research, delivery programs, and case registries for ongoing outcome evaluation should get higher priority.