Cardioversion: Past, Present, and Future. The remarkable Dr. Abildgaard and countershock. The bicentennial of his electrical experiments on animals. Ann Intern Med. History of mouth-to-mouth rescue breathing. Part 2: the 18th century. Crit Care Resusc. The Holger Nielsen method of artificial respiration. Photo courtesy of Laerdal Medical Corporation. Chest elevated, a victim is pulled up on his side momentarily, then rolled back. Pressure on back expelled air.
Arms moved forward, folded on chest and pressed. Tongue held, keeping air passage open. Moritz Schiff and the history of open-chest cardiac massage.
Modern cardiopulmonary resuscitation—not so new after all. JR Soc Med. Clin Cardiol. Blood Pressure in Surgery: an experimental and clinical research. Cartwright prize essay for J R Soc Med. Kouwenhoven: Reviving the Body Electric. Johns Hopkins Engineering. Elam, MD Image Dr. Safar performs mouth-to-mouth resuscitation in Baltimore, Reprinted by permission from the Safar Center for Resuscitation Research.
Image l to r Dr. Saving more lives - together. The vision for Laerdal Medical Corporation. The strong smell caused a sneeze or similar robust exhalation through nasal irritation and helped to recover respiration [ 3 ].
This can be repeated several times until the patient can breathe smoothly. When the patient recovered respiration, then drug assisted rescue, such as with the powder of websterite and clove a kind of traditional Chinese medicine cooked in a soupwould help them to wake up. This book emphasized resuscitation methods with artificial respiration and this was the basic of modern resuscitation in China. The ancient Chinese physicians combined the steps for first-aid and they paid more attention to artificial respiration in the Jin and Sixth Dynasties.
It is the earliest record of the etiology, pathogenesis and syndromes of diseases in China. Although hanging was known to close the Yin and Yang main and collateral channels, some Yang Qi remained around the viscera, so the hanged man might be saved.
Several points were presented: 1 cardiac resuscitation should begin as early as possible, 2 it was equally important to restore breathing and circulation [ 6 ]. To resuscitate a person, it said to lay them flat, plug their ears, and insert a hollow bamboo tube into their mouth.
Two people alternately blew into the tube. Efforts were to be ended half a day later if the patient was not resuscitated. Another method had rescuers blow an irritating or strong smelling powder into the nose. As patients recovered consciousness they were fed Lan Qing Juice a type of traditional Chinese medicine.
In a fourth step of resuscitation, rescuers applied acupuncture and moxibustion to points in the limbs [ 7 ]. This was also a prototype of an oropharyngeal airway. Still, both of these work had great influences on later generations.
According to recent research the book should be ascribed to the North Song Dynasty, but the writer is unknown [ 8 ]. We used to think the writer was Hua Tuo. All of these history is the basic of mouth-to-mouth resuscitation in modern medical. Also, since Napoleon came after , Tossach should come first [ 12 ]. The Paris Academy of Sciences officially recommended mouth-to mouth resuscitation from drowning in the year The Chinese techniques of cardiopulmonary resuscitation had spread to Japan and were widely accepted.
These treatises emphasized the difficulty of saving a hanged victim, especially if they were hanged with a fine line and cut deeply. In these cases, rescuers should be quick to lift the person and untie the knot without cutting the rope. The rescuers were to rub the ligature mark left by the line, and manipulate the trachea while pressing the chest and belly.
Another rescuer performed mouth-to-mouth resuscitation. Raising the head should be done quickly and the head should not be lowered. If the arms and legs of the hanged man were rigid, they must be folded, like a monk sitting. Meanwhile, the powder of the Pinellia ternata and Chinese Honeylocust fruit were blown into the nostrils with two bamboo tubes. Point stimulation with acupuncture and moxibustion were employed to assist resuscitation. The stomach was infused with strong ginger and Su He Wan made of styrax, benzoin, sandalwood, rhizome cyperi, costustoot, clove, frankincense, Illicium verum , cinnabar and bornrol to restore consciousness, borneol and styrax to smooth whole body meridian and others to disperse cold air in the body [ 13 ]..
The Qing Dynasty made the following contributions to CPR: 1 the previous experience was incorporated, 2 the resuscitation methods complementary and improved by acupuncture and medicines, 3 the boundaries of resuscitation were clarified, 4 the resuscitation procedures of up to more than 10 steps were promulgated. Reviewing the CPR history in ancient China, we have to admit that we have fallen behind in the field of Cardiopulmonary Resuscitation after more than a century.
In China, there are more than million people with cardiovascular disease, and , individuals experience cardiac arrest every year. Early initiation and good quality of cardiopulmonary resuscitation CPR by bystanders and automated external defibrillator use are crucial for saving patients in cardiac arrest. However, the implementation rate for bystander CPR in China is low 4. At present, CPR is more often implemented in medical schools and hospitals.
The public awareness rate outside the hospital is low. Without legal support, the right of rescuers is not protected by the law. Institutions and forms of CPR training are mixed, many irregular training misleads the public. There is no unified and normative training material with the national standard. However, most of the CPR trainers are part time job, they are under too much pressure of clinical responsibilities and CPR skills need to be regularly evaluated and updated.
So that, it is necessary to have an organization with full-time job trainers to do this. In July, , they created more activities in order to raise the concern of the whole society on health of the cardiothoracic and vascular systems, and to popularize the scientific standardized knowledge and technology of CPR. This initiative was based on the emergency medicine concept and aimed to popularize the normative method of CPR, increase public participation in this life-saving actions, spread public welfare concepts, maximize lifesaving, reduce mortality, alleviate pain and reduce disability, and improve public health awareness and general knowledge of CPR.
CPR will benefit more people if we effectively popularize this technique. CPR could save more lives, reduce death and disability, improve public health level, reduce medical and health expenses, strengthen construction of medical codes, push reformation of medical and health system and promote the social responsibility of each citizen and social progress. It was accepted widely by neighboring countries and provides some new ideas of modern medicine. This was clearly a precursor of CPR.
Not only in China, there also have records in other ancient countries. The remarkable red ochre drawing of a mammoth in the Pindal cave in Spain, presumably of the Paleolithic period, showing a leaf-shaped dark area where the heart should be, may depict the first attempt by humans to relate disease and death to the heart.
At that time a supernatural orientation to health and disease was fundamental. Intruded spirits had to be driven out by magical-religious formulas. This speculation regarding life in prehistoric times, however, has been based on the analysis of those interpreting evidence such as Paleolithic art.
It was only with the advent of written records that any true interpretation of early medical practice was provided [ 15 ]. In addition, to overcome hesitation toward mouth-to-mouth contact, it was suggested to ventilate through reed or bamboo tubes. This was a prototype of an oropharyngeal airway. Further exploration of the lengthy history of CPR and its antecedents in China can provide us new thinking and spaces to explore insights into cardiopulmonary resuscitation.
In conclusion, CPR in ancient China stared really early, but it developed slowly in later years. According to the history, we realized that it is necessary for us to inherit the wise of ancient people. The year before, the Harvard cardiologist Paul Zoll made the same discovery. In their studies on the defibrillation of dogs, they applied paddles with pressure on the chest of the dog and obtained a femoral pulse. A technique already described 16 by British dentist John Hill in and resumed several times in history that the group Kouwenhoven was perfected in order to be able to compress the heart without damaging the chest and abdominal structures.
He described 17 massaging the heart of a boy with his hands for 45 minutes in ventricular fibrillation and subsequently performed the defibrillation with an internal electrical defibrillator developed by the scientist and friend James Rand. The external defibrillator already became known, thanks to Dr.
Zoll then used direct current DC thanks to the discoveries of Bernard Lown in the early s, showing that the direct current was equally effective and safer John Geddes 19 installed on ambulance Belfast it weighed 70 kg and was connected to the battery of the vehicle.
Only three years later, a 3-kilogram portable version became available. In , thanks to the research of Dr. Levi Watkins and Dr. Vivien Thomas , the first implantable cardioverter defibrillator ICD was marketed.
Taking a little step back to the past , during the polio epidemic in Minnesota, physician James Elam applied mouth-to-mouth respiration on an affected child. In four breaths, he was pink. He had come across the technique the previous night when reading a book on the history of neonatal resuscitation.
This episode guided his subsequent research with the physician Dr Peter Safar. Together they demonstrated the effectiveness of their technique of artificial mouth-to-mouth respiration. From their work spreading ideas to the scientific community and to the general public arose the need to introduce manikins for training in ventilation techniques.
He was a Red Cross volunteer in Kalamazoo, Michigan. The second manikin was designed by Safar and the Norwegian toymaker Asmund Laerdal.
It become the most famous in the world: CPR Annie was a manikin with human features and size. However, the formal connection between the ventilation techniques of Helam and Safar and the cardiac massage and defibrillation procedure of Kouwenhoven and Jude took place in September at the annual meeting of the Maryland Medical Society, where they were presented for the first time together.
It was the birth of modern CPR. During the world tour to promote to the public the newly-formed CPR Safar, Kouwenhoven and Jude assigned director David Adams to produce an educational video. The defibrillator arrived on the scene in , thanks to professor Pantridge, who formed the first coronary care unit in Belfast Mobile MCCU.
Professor Pantridge reported 22 in that of patients treated by the MCCU staff over 15 month-period , half had heart attacks in progress and 10 were rescued with a cardiac arrest in progress. All 10 were resuscitated and admitted to the hospital, an amazing achievement.
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