An unusual cardiac incident in the NFL last year brought up some confusion online. So let’s clear up a few misconceptions on the process of pounding the fuck out of someone’s chest to save their goddamn life.
Today’s Moment of Science… The absurd history of cardiopulmonary resuscitation.
All death is ultimately caused by a lack of oxygen to the brain. Doesn’t matter if the death certificate says it was a case of the Mondays, autoerotic glassblowing, or trampling emus (my band name). Get that oxygen and get it fast; without it, brain cells start dying in just three to five minutes. Over a few millennia, we’ve attempted some, uh, festive ways to pump the precious life-affirming stuff into people.
Back in the day, Traditional Chinese Medicine was simply… medicine, and far ahead of its time. In Synopsis of Prescriptions of the Golden Chamber, published around 200 BCE, Dr. Zhongjing Zhang described a sort of proto-CPR. With the patient laid flat, the airway was opened by pulling their hair. Then chest compressions were performed, followed by lifting the arms and pushing up on the diaphragm to promote respiration. Hijinks including raising the feet, plugging the patient’s ears, and acupuncture were added in some revisions of the procedure. An early version of mouth to mouth was also documented, in which two people took alternate turns blowing air into the patient via hollow bamboo tube.
With this largely sorted out by the time of the Tang Dynasty, you’d be forgiven for thinking that CPR had been spread worldwide before someone had a chance to suggest “maybe throw them over a barrel.” Well.
It’s hard to pinpoint exactly when and where some of the kinkier European ideas originated. Since a warm body was associated with life, the heat method involved applying something warm to the body. Like hot water, warm ashes, or flaming shit. Then the flagellation method, much to the delight of your 14th century sadist, involved beating the unresponsive. You know, to see if they’d respond.
Paracelsus, the father of toxicology, came up with a method in the early 1500s that would remain in use for the next three hundred years. Bellows were more commonly used to stoke a fire, but the device could just as easily blow air into lungs. When it was demonstrated that this contraption could kill an animal via lung distension, the method fell out of favor.
In the late 1700s a few techniques started showing more promise than burning or beating a dead body. The inversion method of holding someone up by the ankles had some success with drowning victims. Then came the barrel method. This involved throwing someone face-down over a barrel, holding them by the ankles, and rolling them to and fro in hopes of causing some sort of mechanical respiration.
Tobacco smoke enemas had been around for some time, but when a man used it to save his wife from a near-drowning incident (fucking allegedly), they became the new go-to treatment. The Institution for Affording Immediate Relief to Persons Apparently Dead From Drowning in London made sure that smoke enema kits were available all around the Thames for an afternoon pick-me-up I mean to save people from drowning. However, during a time of cholera, shoving an unwashed tube into the unwashed asses of unconscious British peasants wasn’t a great way to save lives.
I’m pretty sure they used those kits on conscious people too, but like, for funsies.
Then came the Russian method: putting the unfortunate body under a pile of snow. How… Russian.
In 1812, the trotting horse method came along. It involved plopping a drowning victim on a horse like a sack of potatoes and trotting them about to compress and relax the chest cavity. It’s unclear how well this worked, but Citizens for Clean Beaches was not having this horseshit. The practice was banned in the US in 1815.
By the late 1800s, doctors had reported success using various chest compression techniques to revive humans and animals. Even so, it would take nearly another seventy years of mucking about with mouth-to-mouth and other methods of not saving patients before modern CPR was mostly sorted out.
That said, CPR is a fucking nightmare.
Ribs reportedly break in 30% of cases (though studies vary wildly on this statistic). A bruised chest, collapsed lung, and the potential for so, so many complications if the patient vomits is… a lot.
“But Ms. Auntie SciBabe,” I hear the one remaining optimist who reads this column ask, “CPR works all the time, so it’s cool, right?”
It works better than anything else we have. That’s not high praise when ‘anything else’ includes a good flogging, blowing smoke up your ass, and the Russian winter.
When performed outside of the hospital, survival rates are 5-10%. In a hospital, with all the equipment and expertise in the world, it’s about 20%.
The role of CPR in medicine is commonly misunderstood. This procedure is used to keep as much oxygen as possible flowing so those precious brain cells stay alive until more advanced care can be administered. It only generates about 20%-30% of the typical blood flow, and generally does not restart the heart. It’s ugly to watch, exhausting to perform, and the chances of failure are high.
It’s also emergency care that’s saved countless lives, requires minimal training, and the only equipment needed are your bare hands.
This has been your Moment of Science, wondering how barbaric we might consider CPR to be in another few millennia.
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