Late one evening in December 2014, a healthy 55-year-old man returns home from a lengthy bike ride, chats with his wife and two daughters, and heads upstairs alone to watch television. Then, two storeys up from his family, his heart suddenly stops beating. A minute or so later, his wife discovers him on the floor. He’s already turning blue. He’s not breathing and has no vital signs. The man is dead.
Scenes like this — cardiac arrests outside of a hospital — happen about 40,000 times a year in Canada. They occur in homes, offices, gyms, airports, on streets and in parks. So often do they happen that we rarely hear about them in the news.
So here’s why I am telling you about this particular death: That dead man was — is — me.
I am alive and well because my wife knew what to do. She yelled to my daughters to call 9-1-1. The ambulance would arrive just under eight minutes later. But neither my heart nor my brain would be much good after eight minutes without oxygen.
Luckily for me, Patricia, my wife, knows CPR. She started immediately and continued compressing my chest until the firefighters and paramedics arrived. By pushing hard and fast on my chest for those long minutes, she kept crucial blood circulating to my brain and organs.
Less than a week after it happened I was back home. Less than a month and I was passing my treadmill/cardiac stress test with flying colours. All because of CPR. (Learn the basics here.)
The origins of emergency resuscitation date back to the 18th century. In 1740, the Paris Academy of Sciences officially recommended mouth-to-mouth respiration and compressions of the abdomen for drowning victims pulled from the River Seine. Within 30 years similar groups appeared in England and Holland. Still, it would be 200 years before CPR became the norm.
In 1958 at Johns Hopkins University, researchers accidentally discovered that external compression to the chest of a dog in ventricular fibrillation resulted in a pulse in its femoral artery. With that happenstance, CPR as we know it was born: it wasn’t long before this life-saving discovery began to be used on humans in hospitals. In those early days, CPR was called “closed chest massage,” to differentiate it from the version with the chest cut open, in which the doctor literally reached in and squeezed the exposed heart.
Remarkably, it was about the same time and place, after about a century of experimentation and innovation most notably in the USSR, that William Kouwenhoven, an electrical engineer at Johns Hopkins, invented the first closed-chest defibrillator that could deliver repeated shocks to an adult heart to restart it.
Emergency cardiac care in the modern sense begins at that moment.
Dr. Fred Wilson, a retired neurologist now living in Canmore, Alta., told me an amazing story of his first successful CPR intervention with defibrillation — possibly the first in Canada. It was 1964 and Dr. Wilson was just a few weeks out of medical school, when a female patient in her 60s arrived in emergency complaining of chest pain.
“Then, right before my eyes, she collapsed and went into cardiac arrest,” he recalls. “I hadn’t been taught cardiac resuscitation in med school, but I had heard about it. I figured I’d better give it a try.” He knew there was a defibrillator in the operating room five storeys up, so he sent a nurse to get it while he started CPR. When the defibrillator arrived, it took only a few seconds to bring the patient back to life. She went on to make a good recovery. After a second similar incident, the hospital instituted a cardiac resuscitation team and what is now referred to as a “crash cart.”
Expanding beyond hospital walls
Within just a few years, the medical establishment had figured out that immediate CPR was (a) the best hope for cardiac arrest survival and (b) simple enough for anyone to learn.
Of course there were many medical and legal implications to turning it into something that could be delivered by members of the public. I turned to Dr. Anthony Graham to learn more about CPR in Canada. He is medical director of the Robert McRae Heart Health Unit at St. Michael’s Hospital in Toronto and is a clinical cardiologist with long-standing interest in cardiac rehabilitation and quality improvement. He was the first chair of the Heart and Stroke Foundation’s CPR committee and a very active member of HSF in Ontario. He recently was inducted into the Order of Canada for his pivotal part in advancing CPR and emergency cardiac care over the past 40 years.
“It was 1976 and I was a young cardiologist in Toronto. I was asked to be part of a group convened to figure it all out, everything from assuring legal protection for laypeople and passers-by who deliver CPR, to the best way to train people. It was a huge undertaking,” says Dr. Graham. “We were inventing an entire system.”
Then the actual training started, with assistance from the American Heart Association. “It was incredibly tough, with hours and hours of practice of the right way to do compressions and constant interruptions for breathing, all while kneeling over the ‘patient,’” says Dr. Graham of those first programs. “We all had painfully sore knees and bruised lips” from repeated practice on early versions of “CPR Annie,” the practice mannequin often called the “most kissed face in the world.”
Since then, simplified teaching for the general public now includes doing chest compressions only — no breaths. And this training is offered in short, easy-to-learn public training events or with at-home video kits.
Thousands of lives have been saved by bystanders responding to cardiac arrest in homes and public places. Close to half a million Canadians learn CPR each year through the Heart and Stroke Foundation’s extensive network of trainers across Canada. The Foundation continues to increase those numbers.
Using research to improve outcomes
From the beginning the Heart and Stroke Foundation has been leading a process of constant improvement and refinement of CPR. Not only has it emerged as the lead institution for promoting and teaching CPR across Canada, the Foundation is a founding member of the International Liaison Committee on Resuscitation (ILCOR) which reviews new science and works constantly to improve the technique and its delivery.
Members of ILCOR congregate every five years to review and adopt recommendations to improve resuscitation and first aid training and practice. Learn more about the latest Canadian guidelines, including new Consensus Guidelines on First Aid.
And while comprehensive, certified training is still the gold standard, CPR for untrained bystanders has been vastly simplified. The hope is that more bystanders will step in to help — and compression-only CPR is the key to saving many lives.
Now, the Heart and Stroke Foundation is part of a research initiative intended to take CPR even further: CanROC, the Canadian Resuscitation Outcomes Consortium, is the latest effort of an ongoing pan-Canadian research network involving 10 large EMS systems, including the Greater Toronto Area, Ottawa and Vancouver. With new funding from the Foundation and the Canadian Institutes of Health Research (CIHR), work has begun to create a national cardiac arrest registry which will facilitate study of outcomes and lead to improved survival rates. In simple terms, there will be more people like me, alive thanks to someone nearby being willing and able to step forward.
Other research innovations — including an app to alert trained bystanders if a cardiac arrest occurs nearby — promise even greater potential to save lives. And along with the advances in CPR, the Foundation has worked with governments and numerous partners across Canada to place more automated external defibrillators (AEDs) in public spaces such as arenas and rec centres.
Since my cardiac arrest, I have learned a tremendous amount, including a deep sense of gratitude. I owe my life and my wellbeing to my wife who knew CPR. And you could just as easily say I owe my life to the Heart and Stroke Foundation and dedicated, caring, medical pioneers like Dr. Anthony Graham.