Evolution of Resuscitation - A trip down the lane

Evolution of Resuscitation

Resuscitation is the most important first-aid given to a person whose vitals show no sign of response. Throughout History, there have been several cases of attempted resuscitations – both medical and otherwise, mostly successful.

Medical science says that immediate resuscitation is important, those first few minutes of revival care may help save a life. Many religious ‘god men’ have claimed to reverse death, and bring back someone who was dead.Some people are of the view that death is decided by God, and what God has decided, men cannot undo.Research shows that resuscitation techniques have been around since many hundreds of years.

Resuscitation in the early ages (upto the 15th century)

In the early ages, people realized that a body that was lifeless began to turn cold as life let it. Hence, they began to associate warmth with life. They would whip the patient to increase warmth and sometimes wrap blankets with coal to bring heat to the body, in hopes that it would help.historyofcpr

How helpful was this? Not much apparently.

In 1000 D, a Muslim philosopher and phycisist proposed that a tube be inserted for tracheal inspiration. The tube would need to be made of gold or silver. In 1628, William Harvey, an English physician, wrote that resuscitation was an arduous task to keep the heart beating through external efforts and maybe it was ‘against the will of God’.

In 15th century England, people would use fireside bellows to blow smoke into the tracheal cavity, keeping the victim alive. A researcher claimed to have kept a dog alive using this method. But how many people walked around with fire bellows? This method was soon scrapped.

The idea behind this however, was successful and hence a more-functional version of this was created in the form of a bag mask valve resuscitator.

 

Resuscitation methods were even more shocking. (17th – 18th century)

A method of sending tobacco smoke into the victim’s rectum was found to lead to stimulation and hence was practiced in North America.This was later scrapped as tobacco was found to be extremely harmful to life.

historyofcpr2Mouth-to-mouth resuscitation first found favor as a method to revive stillborn infants, practiced by midwives in the Early Ages. William Tossach,  a surgeon, submitted a paper describing how a patient of a coal mine accident had survived using this technique. William’s account is the first medical description of resuscitation to be documented in literature.He mentions that, after continuous inspiration through the mouth, with the nose closed and chest compressions, the patient regained breathing. He was in a semi conscious state for a few minutes and then regained consciousness and a pulse was recorded.

This method is most similar to the modern method of CPR practised by paramedics.

Resuscitation as a common practise

Surprisingly, the first city to practise resuscitation was Amsterdam. The most common cause of death there was drowning. Several methods like pressing the abdomen, positioning the feet higher than the head etc. helped in draining out water swallowed by the victim and helped revive the patients, timely use of these methods resulted in at least a 50 % success rate.cprhistory3

Tuffer and Hallion, two researchers noted that open chest cardiac massage involving compressions was vital in reviving a patient. Subsequently, Dr. George Crile demonstrated this method on animals. He combined chest compression + intravenous adrenaline + tracheal inspiration as vital for reviving a patient. He was also the first person to stress the importance of adrenaline in resuscitation efforts.

In 1949, James Elam, an anesthetist, successfully performed mouth-to-mouth on a critical patient and proved that exhaled air (even though high in carbon dioxide) is enough to oxygenate a non-responsive patient.He demonstrated that expired air blown into the endotracheal tube maintained normal oxygen saturation. Even after he had established this, manual ventilation methods were still preferred by the unconvinced physicians of the time.

Mouth- to- mouth vs Manual respiration techniques

In 1957, Peter Safar pointed out why mouth-to mouth was a far better alternative to manual respiration techniques. His profound finding showed that the position of tilting head backwards naturally opened the air passageway and manual expiration provided sufficient air for revival. Needless to say, manual resuscitation could be performed anywhere and by anyone. This fact itself helped this theory gain fame with the people. Needless to say, manual resuscitation could be performed anywhere and by anyone. This fact itself helped this theory gain fame with the people.

Time – the most important factor in resuscitation techniques

The 1970s saw many cardiologists conclude that time is indeed the most crucial factor in determining a patient’s prognosis in cases of myocardial infarcation or a cardiac arrest which is, in simple terms – the heart stops beating, leading to no pulse, undetectable BP and an unconscious state of the patient.

Almost 70% of patients with this condition died before reaching the hospital, leaving only one option. Start treatment earlier.

The last thirty years have seen an increase in paramedics being trained in methods of resuscitation. ‘Mobile care units’ or ambulances equipped with defribilators have seen an upsurge leading to quicker access to health care and immediate attention received for patients.

In conclusion, medical healthcare is a field that will continue to advance along with new discoveries and developments. We have seen how a combination of techniques used in earlier ages have become more refined today to create more quicker access to patients.

One thing is for certain, reversing death requires

  1. immediate care
  2. stability of the patient
  3. recognition of what led to the sudden attack and immediate treatment for the same.

 

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