150 years of resuscitation

Restart a Heart Day is an annual BHF-supported initiative where we try to train as many people as possible in Cardiopulmonary Resuscitation (CPR) in a single day, so that more people know these life-saving skills. Today, we’ll be helping teach 150,000 people CPR to do just that.

Students learning CPR at school as part of The BHF’s Nation of Lifesavers campaign.

Today, 53 per cent of children in UK schools are trained in how to save a life with CPR. This training is something which organisations like the BHF help provide in community groups up and down the country, yet just over sixty years ago the very idea of keeping blood flow going by pressing on someone’s chest was unheard of.

Modern CPR techniques save lives, but it might surprise you that the technique of combining chest compressions, rescue breaths and a defibrillator (if available) is relatively new. In the past, patients were actually cut open and their hearts were massaged by hand.

Early approaches

Modern methods of CPR like those being taught today, and which you can learn about on our website, were preceded by a variety of different approaches. This included The Silvester Method, published by Dr Henry Robert Silvester in 1858, which involved laying a patient on their back and moving their arms from their chest outwards and back 12 times a minute.

Sylvester method of artificial respiration from Anaesthetics and their administration, 4th edition by Frederic William Hewitt 1912. Wellcome Library, London.

Other similar approaches, such as the Holger Nielsen technique, were developed and promoted in subsequent years. These methods focused on helping patients to start breathing again, but did little to restore blood flow. In the 1950s, Dr Peter Safar and his team in the US pioneered modern mouth-to-mouth resuscitation, which today is routinely combined with chest compressions.

If your heart stops and nothing is done to get yout blood flowing again, your brain can be damaged by the lack of oxygen in around four minutes. After just seven minutes, serious brain damage or death is almost inevitable. If someone’s heart stops beating, acting quickly is vital to their survival.

Open chest cardiac massage

A demonstration of an emergency thoractomy, cardiac massage and treatment of cardiac arrest by a medical officer. This video is part of The Wellcome Collection. This video contains footage of open chest cardiac massage.

Starting around the turn of the 20th century, surgeons experimented with “open chest cardiac massage”. This meant literally opening a patient’s chest and massaging their heart to maintain blood flow before using a defibrillator to restart the heart. This technique was popularised in the 1950s with training videos like the one above.

Because of the speed with which blood flow needs to be restored, this technique is only possible if the cardiac arrest occurs very close to an operating theatre. This was just what happened to David Lee, who worked with (now-retired) BHF Professor Desmond Julian at the Royal Infirmary, Edinburgh, in 1960. Professor Julian explained:

“I was very junior so, although I had seen in it done, I had never done it myself before. It couldn’t have been more propitious in a sense. I was next door virtually — it took me a few seconds to get there. I had a scalpel in my hand, and I was gowned up. This colleague David Lee [who has suffered the arrest], we had discussed it, and I felt sort of morally obliged. He was a young chap, 40-odd, and I thought if anybody is suitable for this, he is.”
Professor Desmond Julian when he was BHF Medical Director

Closed chest cardiac massage

Not long after this incident, it would be David Lee who drew Professor Julian’s attention to work from Johns Hopkins University pioneering closed chest cardiac massage — which would become known as CPR. This technique, which was initially trialed in patients who had suffered a cardiac arrest during surgery, soon became commonplace in hospitals and has now replaced open chest methods.

Defibrillation

Every year, thousands of people suffer a cardiac arrest outside of hospital. Chest compressions will keep blood flowing but it’s often necessary to use a defibrillator, which starts the heart beating by delivering a controlled electric shock.

Early experiments with defibrillation began in the 1930s and the first report in a medical journal of defibrillation to restore a normal heart rhythm was published in 1947. By the 1960s large, heavy defibrillators were available in hospitals.

An early defibrillator similar to those first used by Dr Frank Pantridge in ambulances.

In 1964, Dr Frank Pantridge set up a mobile resuscitation unit at Balfast’s Royal Victoria Hospital. He realised that many deaths could be avoided by taking defibrillators to patients, rather than having to bring patients to hospital before providing treatment. One year later, he applied to the BHF for a grant to test equipping ambulances with defibrillators. The success of this trial led us to fund thousands of defibrillators for ambulances, and today all ambulances in the UK carry one.

Today

Around 80 people will suffer an out of hospital cardiac arrest in the UK today, and only about 10 of them will survive. To help change this, we’re working to build a nation of lifesavers by training thousands of people in how to confidently and quickly perform CPR.

Surviving a cardiac arrest requires immediate action — and this is why widespread CPR training and defibrillators being available in public places are so important. In the last twenty years, we’ve funded more than 700 defibrillators in public places across the UK, and since 2014 we’ve trained 3 million people in CPR.

If you have never received CPR training, or if you’d like a refresher, then you can check out our training options.

Tomorrow

Rapidly starting CPR is part of the chain of survival in a cardiac arrest. When a cardiac arrest happens outside of the hospital, the delay in starting CPR can be the difference between life and death. To improve the chances of survival, we’re funding research to see if taking patients to specialist cardiac arrest centres improves their chances. We’re also funding work on improving how CPR is delivered to children in hospital.

If we want more people to survive a cardiac arrest then we need a nation of lifesavers — people who are trained in CPR and are ready and willing to act should the worst happen. Make sure that nation of lifesavers includes you.

Find out more about learning life saving skills at www.bhf.org.uk/restartaheart

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