It was 1960. John F. Kennedy was running for president. Xerox introduced the first paper copy machine. Khrushchev pounded his shoe at the United Nations. And across the country, coronary artery disease had reached epidemic levels. Many men in their 50s and 60s were heart attacks waiting to happen. They smoked, didn’t exercise and ate lots of red meat and foods high in saturated fats. (If you weren’t around then, think “Mad Men.”) Many had uncontrolled high blood pressure. Cholesterol-lowering statins had not yet arrived on the scene.
So it was fortuitous, and a bit ironic, that the year coronary artery disease peaked also marked the birth of modern CPR. Three investigators from Johns Hopkins Hospital in Maryland published a paper in the Journal of the American Medical Association(JAMA) describing a technique of using chest compressions to buy time for patients in cardiac arrest until a defibrillator arrives. Later that year, the technique, which they called heart-lung resuscitation, was combined with mouth-to-mouth ventilation and became known as CPR.
“Unless it happened in the emergency room, cardiac arrest was virtually 100 percent fatal,” said Dr. Mickey Eisenberg, professor of medicine at the University of Washington in Seattle and medical director of King County Emergency Medical Services. “CPR changed that.”
The year 2010 marks the 50th anniversary of the seminal paper in JAMA that launched one of the most significant and widely accessible lifesaving techniques ever developed. Since the advent of CPR, deaths from heart attack have fallen by two-thirds.
Eisenberg said much of that improvement is due to prevention—lower smoking rates along with better blood pressure, cholesterol and diabetes medications. Some is due to improved surgical procedures and cardiac care to treat those with coronary artery disease.
Some of the decrease in deaths from cardiac arrest is attributable to more widespread dissemination of CPR, first to physicians and nurses, later to EMS, and more recently, into communities, Eisenberg said.
Before the 1960s, reviving a stopped heart was solely the domain of surgeons, who could massage the heart through an open chest if they happened to be operating when the problem occurred. With external compressions and the development of more portable defibrillators, resuscitation began to be performed outside of hospitals in the 1970s.
Yet there continued to be resistance to sharing the technique with the general public. “There were a lot of skeptics at the time,” said Eisenberg. “They said people couldn’t do it properly or you can’t teach people to do it in a few hours. Of course, the anxieties of the skeptic were never realized. In fact, people can learn it, and not only can they learn it in a few hours, all of the innovative methods to teach it have shown you can teach it in even less time than that.”
In 1981, Eisenberg launched a program in King County to teach 911 dispatchers to provide emergency CPR instructions over the telephone. After the program began, the rates of bystander CPR increased in the county from 35 to 40 percent to nearly 60 percent.
Today in King County, which includes 1.8 million people living in the city of Seattle and its suburbs, the EMS system saves more than 150 people each year. “Those are people who were literally brought back from the jaws of death,” Eisenberg said.
Yet the work isn’t done, according to Eisenberg. Though telephone instruction by 911 dispatchers is now standard, compliance isn’t often tracked. More emphasis needs to be placed on ensuring it is actually getting done. “We feel very strongly this is a resource-light way to improve your cardiac arrest survival rates,” Eisenberg said.
Still, on a national basis, less than 10 percent of those who go into ventricular fibrillation outside of the hospital survive and are discharged. Eisenberg says efforts should continue to ensure more members of the public know CPR. Though researchers will likely continue to develop better prevention and treatments for heart disease, it is the general public that holds the key to improving those survival rates, and they are who EMS needs to reach with the CPR message.
“The chain of survival starts with someone recognizing the problem, calling 911 and starting CPR,” said Chris Chiames, executive director of the Sudden Cardiac Arrest Association. “Without the public’s knowledge of what to do, EMS is pretty limited in its ability to help cardiac arrest victims.”
Studies have shown the chances of surviving cardiac arrest are roughly doubled for those who receive CPR prior to EMS arrival. If CPR is started right away, it extends the window in which the defibrillator can be effective from 4 to 6 minutes to 10 or 12 minutes.
“The lessons of 1960s are as valid today as they were then,” Eisenberg said. “CPR has to begin in the first minutes of a cardiac arrest and the defibrillator has to arrive at the scene as quickly as possible. If we can spread that message to every part of our society, and make defibrillators as common as smoke detectors, then you will have resuscitation rates of 60 to 70 percent.”