Cardiopulmonary resuscitation review: critical role of chest compressions.

A50-year-old man suddenly collapsed while standing in the waiting area of a local hospital. A physician walking by promptly determined, by the absence of carotid pulses, that cardiac activity had ceased. He then quickly removed a Swiss Army knife that he kept in his trouser pocket, made several chest wall precordial incisions to expose the heart, which he found to be in standstill, and initiated hand compression cardiac massage (all within 3 minutes of the event). Cardiac contractions promptly returned and the patient started to breathe. The patient was immediately taken to surgery and the chest wounds were cleansed and repaired. Subsequent chest wall and pericardial infections were treated using drains and intensive parenteral antibiotics: the patient recovered and was discharged 3 weeks after the event. This was the state of cardiac resuscitative measures in the “1950s” when it was not uncommon for physicians to carry folding knives to be used in sudden death emergencies. It was not until 1959 that Kouwenhoven and Jude first reported on the success of external chest compression as a procedure that could safely and effectively massage the heart and reverse sudden cardiac death. This was the stimulus for the birth of modern cardiopulmonary resuscitation (CPR).