From 1740 to now, changes for better in life support

I recently had the opportunity to refresh my skills in basic life support known as CPR, or cardiopulmonary resuscitation. Health-care providers recertify in this program of emergency care every two years.

It was something of a minor milestone for me as I completed the program for the 10th time. It gave me time to reflect not only on how the program has evolved over the years, as well as the implications of progress in the field of basic life support for the community at large.

The history of basic life support is interesting. Ever watched a movie depicting a period in history in which a character provides mouth-to-mouth resuscitation or chest compressions? Bad scripting? Not exactly.

Mouth-to-mouth resuscitation actually dates back to 1740, when the Paris Academy of Sciences advocated the technique for resuscitation of drowning victims.

According to the American Heart Association, a physician, George Crile, performed the first successful resuscitation using external chest compressions in 1903. The American Heart Association developed the first program of CPR training in 1960, and it remains the expert organization about the topic.

What began as a program for hospital-based medical providers has expanded along with the understanding that early recognition of a life-threatening condition, followed by prompt action based upon simple principles, can save lives. In short, anyone can effectively learn CPR. The skill can be used in the community to prolong survival until definitive medical care is available.

For those who have trained in basic life support, you will recall it is as easy as the ABCs. Well, sort of. The standard teaching of prioritizing airway and breathing support before addressing circulation problems has actually been revised based on new research. Now, the mnemonic is CAB, to reflect the overwhelming importance of circulatory support for an arrest victim.

This has several implications. First, it reflects an understanding that chest compressions are the single most effective basic life saving technique for cardiopulmonary arrest, when instituted immediately and performed correctly. Second, it eliminates any concern that a potential first responder might have of risk to himself or herself from performing mouth-to-mouth resuscitation, since this is no longer an essential aspect of CPR.

Yet here is where recent advances in community-based life-saving technology have really been transformed. The idea of CPR for cardiopulmonary arrest has long been to sustain basic circulation until definitive treatment arrives in the form of a defibrillator.

This device, which uses electrical current to shock the heart back into a life-sustaining rhythm, used to be restricted to use by paramedics and other health-care professionals. Yet, it has been found so effective that almost anyone can use it.

So-called automated external defibrillators, or AEDs, are now in public buildings, on airplanes and at entertainment venues. Our local church even has one.

The fact is that you dont have to be a doctor, nurse or paramedic to save a life. All you need is a pair of hands and a little basic know-how. Training courses in basic life support abound in the local community. Perhaps it is time for you to take the course. You might just save a life.

Dr. Matthew A. Clark is a board-certified physician in internal medicine and pediatrics practicing at the Ute Mountain Health Center in Towaoc.