Cardiopulmonary Resuscitation: History, Current Practice, and Future Direction

At least 350 000 people will suffer cardiac arrest each year in the United States, 1 every 90 seconds.1 Many will then undergo cardiopulmonary resuscitation (CPR) by bystanders and emergency medical services in a desperate attempt to restore life. Numerous studies report that the majority of these efforts will not succeed. Prolonged anoxia, the inability to restore spontaneous circulation, neurological devastation, and other complications combine to limit survival. Nonetheless, thousands will surmount these obstacles and resume normal lives. CPR is a triumph of medicine but also is frequently performed in vain. It is a young science; the term “CPR” was first publicized less than 50 years ago. The roots of resuscitation, however, extend back centuries, with a gradual course of evolution that has been periodically impeded by rejection of inadequate techniques, curiously slow adoption of proven interventions, and even a cyclic process of abandonment and subsequent rediscovery. Examining the history of resuscitation is an essential first step to understanding and following the evolution to modern practices. A detailed review of more current observations, inventions, and clinical trials, in the context of the disappointing statistics of conventional CPR, will elucidate the rationale behind the most recently published resuscitation guidelines, as well as provide fuel for future research. Although components of life support apply to the predominantly asphyxia-related arrests seen in pediatrics, the focus of this review is on resuscitation after cardiopulmonary arrest in the adult. ### Airway “But that life may… be restored to the animal, an opening must be attempted in the trunk of the trachea, into which a tube of reed or cane should be put.” — Andreas Vesalius, 1540 2 The Babylonian Talmud, a sixth century collection of Jewish oral tradition, records that a lamb with a neck injury was saved by a hole into the trachea, supported by …