Cardiopulmonary resuscitation research 1960-1984: discoveries and advances.

The 24-year history of cardiopulmonary resuscitation (CPR) can be divided into four eras. The first (1960-1962) was the era of serendipitous discovery and description of "closed-chest cardiac massage" by Kouwenhoven and colleagues. Closed-chest heart massage was combined with artificial ventilation, and became known as CPR. The second (1962-1968) was the era of skepticism, in which CPR was challenged by investigators whose observations of hemodynamics were not in concert with the proposed mechanism of blood flow. The equality of arterial and central venous pressures during chest compression seemingly belied the proposed mechanism of blood flow during CPR, and raised questions about the effectiveness of the technique. The third era (1968-1976) was one of acceptance and complacency. The effectiveness had become established through widespread use in coronary care units, catheterization laboratories, and prehospital emergency systems, and open-chest cardiac massage was completely supplanted by CPR in virtually every resuscitation effort. The current era (1976-present) is the era of rediscovery and refinement, beginning with the observation that blood flow and pressure can be generated during cardiac arrest by coughing ("cough CPR"), without actual compression of the chest or heart, and that augmentation of arterial pressure and carotid blood flow resulted from simultaneous compression and ventilation (SCV-CPR or "new CPR"). The current era has provided a new explanation of the mechanism of blood flow during CPR and alternative methods of maintaining perfusion during cardiac arrest.(ABSTRACT TRUNCATED AT 250 WORDS)