Initiation of closed-chest cardiopulmonary resuscitation basic life support. A personal history

Abstract

Modern external (closed-chest) cardiopulmonary resuscitation (CPR) basic life support (BLS) gives everyone anywhere a chance to initiate the reversal of death from airway obstruction, apnea, or pulselessness. The history of modern CPR has its roots around 1900, but lay dormant for half a century, until in the 1950s several fortunate circumstances merged to allow for documentation of Steps A (airway control by head-tilt and jaw-thrust), B (breathing control by mouth-to-mouth ventilation), and C (circulation control by closed-chest cardiac massage, i.e. chest compressions) and their combination into BLS Steps A-B-C. BLS is only for borderline emergency oxygenation, i.e. Phase I of the life support chain. Both the non-authoritarian environment of the U.S.A. and several role players with keen interest in resuscitation were needed to enable the systematic research (Steps A and B), a chance rediscovery (Step C), and the integration of BLS with advanced life support (ALS, drugs and defibrillation, transferred from open-chest CPR) and brain-oriented prolonged life support (PLS, intensive care) to result in the development of an effective cardiopulmonary-cerebral resuscitation system. A fertile environment led rapidly to the development of resuscitation delivery systems in hospitals and communities. This paper is a story told by one of the role players.