The amazing story of CPR

CPR is so simple that anyone can use it to save a life. But how did we get here? One man who owes his life to CPR went in search of the facts.
Senior woman being given oxygen in an ambulance caregiver at side

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 60,000 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 without oxygen-carrying blood pumping through the body, brain injury can begin within as little as five minutes.

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.)

Earliest days

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 Heart & Stroke’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, all with the goal of saving more lives.

Heart & Stroke, through its nationwide network of more than 8,000 instructors, provides resuscitation training to hundreds of thousands of Canadians each year, from members of the general public to healthcare and emergency services professionals, using the best-in-class resuscitation training programs that we have developed from the most current science.

Using research to improve outcomes

From the beginning, Heart & Stroke has been leading advancement, promotion and teaching of CPR across Canada. Heart & Stroke is a founding member and the only Canadian council representative on the International Liaison Committee on Resuscitation (ILCOR), an organization that reviews resuscitation research and science and summarizes the evidence-based findings into treatment recommendations. Through its role in ILCOR, every five years Heart & Stroke adapts these treatment recommendations for CPR, emergency cardiovascular care (ECC) and first aid into guidelines for all of Canada. Learn more about the latest Canadian guidelines: 2020 Guidelines for CPR & ECC

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 up and take quick action — doing hands-only CPR and using an AED – to help save more lives.

Heart & Stroke is also a founding partner and primary funder of the Canadian Resuscitation Outcomes Consortium (CanROC), a national network of resuscitation researchers and one of the largest resuscitation registries in the world. Collecting data from multiple sites, CanROC aims to increase survival from cardiac arrest for the Canadian population. 

Other Heart & Stroke initiatives include an app to alert trained bystanders if a cardiac arrest occurs nearby and ongoing work with governments and other partners to place more automated external defibrillators (AEDs) in public spaces across Canada.

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 Heart & Stroke and dedicated, caring, medical pioneers like Dr. Anthony Graham.