Sawbones: A Marital Tour of Misguided Medicine - Sawbones: CPR

Episode Date: April 23, 2024

Squishing someone’s heart and blowing air into them to bring them back to life seems so basic, so why weren’t we able to agree on it for the past few hundred years? This week on Sawbones, Dr. Sydnee gives an overview of the evolution of CPR which, despite what movies and TV would have you believe, isn’t quite an infinite cheat code for avoiding death.Music: "Medicines" by The Taxpayers https://taxpayers.bandcamp.com/

Sawbones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, this one is about some books. One, two, one, of misguided medicine

I'm your co-host Justin McElroy and I'm Sydney McElroy and I am so excited said to be be dovetailing off maybe the beginning of another one of our our famous combo chains of You really love when we do combo chains of episodes. Is that a video game thing, do you think? It's like gamifying podcasting in a way that it doesn't need to be, but I do like the idea that you can like dovetail between them. I don't know, it's like everybody is trying

to get natural segues, right? That's one of the first things you learn. And then once you nail that, you're like, well, I'm done. And then you see it out there at the distance, the elusive segue, not between bits, but between episodes. And then it sort of becomes your Everest, you know? I don't know.

I like, I always like to be surprised by the topic. Like, ooh, this will be a fun, like I just stumble upon something, like a listener sends us an email or whatever. You ask me a question. So knowing the next topic in advance sometimes is a little bit of a... You like to just have your antenna out

and let the universe kind of pipe it in. I love that. Exactly. We'll see. But no, we are building off of last week's episode, which was about the Lazarus Syndrome. Yes. Where people just come back to life sometimes,

very rarely, usually very briefly, but they do. Auto resuscitation after cardiopulmonary resuscitation. Or Lazarus syndrome if you want to sound like a human being. Well, that too. Anyway, we're going to talk about CPR. Now, let me say this, cardiopulmonary resuscitation, that's CPR. I'm going to say CPR.

Everybody kind of knows that abbreviation. I think considering it's a shortened version of the other thing, that's perfectly acceptable for you to say CPR. Well, that's a lot. It's a mouthful otherwise. CPR, to do the entire history of all of CPR, would be an epic, like, three-hour long or longer episode of Sawbones. There's so... I mean, because it's a lot of things that are put together into one thing, right? There's chest compressions and how did we get to those?

And there's breathing for people, whether we're talking about mouth to mouth or using a bag mask or intubating people. Like there's all the ways we breathe for people and there's the whole history of that. And then there's like shocking people with like a defibrillator and there's the whole history of that.

So, and which we also, we've done electricity and medicine. Yes. And so like that kind of leads it. So we've kind of covered some of this ground. Anyway, it's a lot of stuff. We're a bit more focused. Yes. So, well, I'm, instead of focusing in on just one area,

cause I also don't know that those are particularly interesting each unto themselves to you, the listening audience who I think is seeking entertainment. So this is more of a general overview, is my point. I'm giving you the general, when did we start thinking about bringing people back to life, so to speak? Not really that, but sort of.

And how did we get to where we are now? So the concept, when you talk about, whenever you read an article about like the history of CPR, they always want to trace it back to ancient origins. They're always like, the idea of breathing life into someone dates back to ancient Egyptian writings or to biblical references. And I don't know that that was, I think more like breathing life into like clay, you know what I mean? That kind of usage of like that kind of, a little bit more, you know, making a homunculus, not necessarily a, bring your friend Danny back to life.

Exactly, I don't think they're talking about literal mouth to mouth resuscitation when they talk about breathing life into someone. I do think the idea that we, I mean, we've been, all of medicine is an attempt to stop death. So it makes sense that CPR almost certainly dates back to the origins of humanity and mortality.

And man, this is getting real dark. My point is, I'm sure we've been trying in some way to stop people from dying or bring them back to life when they've died for all of human history, certainly. I mean, let's hope so. There was the one era between like Cro-Magnon and Paleolithic Man where it was just like, I don't know, you win some, you lose some.

Like, well, we'll figure it out. Give us a few millennia. We haven't even done language yet. We have no hope here. So CPR, let me get into what is CPR. What is CPR? Do you know what CPR is? Cardiopalmater, chest pulmonary resuscitation.

What are we doing when we do CPR? What are we trying to do? You're trying to bring somebody back to life, trying to get their heart going again. Yes, we're trying to pump oxygenated blood through someone's body. The heart is supposed to do that when someone has had a cardiac arrest,

then what has happened is either the heart is not squeezing at all. Not gushing the blood through the body. Or it is beating in a way that is not squeezing at all. Not gushing the blood through the body. Right, or it is beating in a way that is not effective at pumping. It's not pumping. Beating ineffectively. Yes.

It's moving around, it's jiggling and wiggling, but not pumping the blood. Yes, exactly. So like a good example of that is fibrillation, especially like ventricular fibrillation. The ventricle is the big meaty part at the bottom of the heart that squeezes the blood through the whole body. Very appetizing. It is, it's the big meaty part at the bottom of the heart that squeezes the blood through the whole body.

Very appetizing. It is, it's a big meaty part. And if it is just sort of quivering or fibrillating, then blood's not being pumped. Right. Okay. Okay, so we need to get that going. Yeah.

We usually do chest compressions. That is the primary thing we're doing, which if you haven't seen them, then you haven't seen Madam Webb, I'm assuming. Yeah, if you need some great examples of what not to do. There's like 13 to 15 different scenes of people performing CPR to various degrees of effect. No, it always works almost,

but it would not in the real world. It always works, and they know it works without checking for a pulse, which is wild to me. Do you know how many times they stop CPR and go, they're fine, or like... They're back. They're back, and they haven't checked for a pulse? It's anyway. So usually we're doing chest compressions, meaning we're like using our hands to push

firmly and deeply into the center of the chest to pump the heart. You're trying to physically pump the heart. You can also involve breathing efforts, whether we're talking about mouth to mouth, or which, I mean, I think that's self-explanatory, but you're putting your mouth on someone's mouth and blowing air into them. Or using like a bag mask, if you've seen like an Ambu bag,

the big plastic bag attached to the mask, or actually putting an airway in. For instance, if you're watching ER, this usually involves a pin in the trachea. That is not standard of care. You are throwing a lot of shade for somebody who's watched three seasons of ER in two weeks. It's just, it's a really good show.

I don't know if you've heard of this show ER. Michael Crichton was involved. Yes. Anyway. It was a whole thing. George Clooney is on it. It was a whole moment. It's great. So there are exceptions.

When I talk about like sort of the standard of CPR, I'm talking about what used to be the ABCs, what's now the CABs. I'm going to go into what that means. There are specialized scenarios, like for instance, respiratory arrest, what used to be the ABCs, what's now the CABs, I'm gonna go into what that means. There are specialized scenarios, like for instance, respiratory arrest, when someone's heart is still beating,

but they're not breathing. This happens a lot in my line of work, because I take care of a lot of people who have substance use disorder, and therefore at risk for overdosing, especially on opioid medications, which that suppresses your respiratory drive. So your heart might still be pumping,

but you're not breathing in oxygen for your blood. So then your blood isn't oxygenated. So then you give them like Narcan and that knocks the opioids off the receptors and gets it going again for some period of time. Exactly. And in those cases, if I am going to intervene, I'm probably gonna do rescue breathing,

whether it's mouth to mouth or a bag mask, because typically they do not need chest compressions because they still have a pulse. But the thing is, and I wanna stress this, this is not what I'm about to share with you, any sort of CPR training course. I am not teaching you CPR. I'm giving you, any sort of CPR training course. I am not teaching you CPR. I'm giving you some examples, why we do, how we do.

No, I am not training you. I'm not certified to train you in CPR. Just because I know it doesn't mean I can teach it, right? Like that is not, that I am not certified to teach someone BLS or ACLS, any of these things. So if you would like to learn these skills though, I guarantee you in your local community at either the Red Cross, the health department,

maybe through the fire department, maybe through EMS, check your local library for where these classes are available. A lot of times there are free classes or maybe for a small fee, you can learn how to do basic life saving and CPR all on your own. And I would highly recommend that.

This is not what this is. I'm just telling you about these things. You have not been trained by me. In old CPR, we would always do what we call the ABCs. And that stands for Airway, Breathing and Circulation. That is no longer the order in which we address things. Now it's CAB, circulation airway breathing. Okay, at least that stayed the same.

That is because we found that a focus on high quality chest compressions, meaning knowing how to do a chest compression and doing it properly is your best chance of keeping someone alive until you can get them into some definitive care, right? An ambulance or a hospital or whatever. Or looking at you, Adam Scott, with your one-handed chest compressions. That is nothing. That was nothing.

He was barely moving his hand. And a lot of times, you will see, if you're watching like a movie or a TV show where people are doing chest compressions, they're not doing them as firmly and deeply as you would need to, but there's a good reason for that. What? If this is an actual actor, they're performing them on.

They can break their ribs, right? They can break their ribs. If you are doing them properly, you will injure the person you're doing it to. Not good. So, that makes sense. When we talk about like our kind of concept of what sort of things do you do to a human

to try to get them breathing again, we can go all the way back to the fifth century to a Persian physician called Dr. Kermani, who was the first one to sort of say, here's some ideas about some things you could do. If someone has stopped breathing or their heart stopped beating, or in some way they seem to be dying.

And the description is, if the patient had weak pulse or pulseless and yellowness, which I think they mean like their complexion has changed because they're not circulating blood, shake him, stimulate and move the arms and the left side of patient and compress the left side of his or her chest. So what's really interesting about that is you see a couple different things, like the idea of trying to like stimulate somebody to get them breathing again, but also the first sort of mention of chest compressions.

The concept of like pushing on the outside. Maybe we can get it going on our own. Yeah, to make the inside thing beat, which is pretty cool. Now this was long before we would have a standardized way of doing that, but you can see that we were already thinking about is it possible to just, I love that too. It's just so like, it's just such a clear practical thought like, well, it's right under there.

Can we just push on it? Push it over and over again? Push it. For a while after that, people tried the bellows method. Well, like getting actual bellows and- Using like fireplace bellows. So if you've ever seen, I don't know, if you haven't seen a fireplace bellows,

which I'm sure you could Google, but it looks like a big kind of like accordion thing that as you open it up, it pulls air in, and then as you push it, it pushes air back out. Like Miracle Max. Exactly like in The Princess Bride. Okay. Yes, except instead of just pumping air into somebody

so you can ask them a question, you would try to get them breathing. So, blaaay. I don't have stats on this. Yeah. I'm gonna guess it wasn't very effective. Yeah, it doesn't seem like it. Although it works in the movie, I mean, to be fair.

Just to make him talk. Yeah, that's true. They give him a magic pill to make him come back to life. Chocolate coating basically, that is. Which is not, as far as I know, there is no magic pill that I can just give somebody that's coated in chocolate to bring him back to life. Yeah, I know the doctors are keeping it from us.

It's all right. I will say, I think this is a good moment to mention, part of why the fireplace bellows thing would not necessarily be effective and may well do more harm is a good illustration of why we fireplace bellows thing would not necessarily be effective and may well do more harm is a good illustration of why we don't hand out. If you've seen somebody use an Ambu bag, the little bag mask thing,

we don't just like toss those out to everybody to use. You kind of need some training to understand how to use them because you can push air into the lungs much more effectively with that than you can just mouth to mouth, right? And you can push too much air in. I mean, if you're pushing hard enough,

you could actually rupture a lung, you'd cause like a lung to collapse. But probably more than likely, the big mistake you can make with those is pumping air into the stomach, and you can make somebody vomit. Fart. No, not fart, vomit.

Vomit. Vomit. And that's bad when you are not conscious because you could aspirate. Okay, but you can see where I would become confused. Yeah, I can see where you thought I was gonna say that. No, I didn't in any reality think you're gonna say the word fart unless you were being legally mandated to by a court of law

but uh, I yeah, I thought and then they're gonna fart come on, then they're gonna have a heart attack and Go ahead a fart attack Things change Indeed Sydney too true too true. But what of the podcast? Things change from the Bellows method. When a doctor in Scotland, William Tosek, brings back a coal miner who had had some sort of, I'm imagining was like had suffocated inside either a collapse in the mine or maybe just because the air inside can be really noxious and so it had collapsed.

Surrounded by 400 people, the doctor performed mouth to mouth resuscitation on this miner for allegedly between 30 and 45 minutes. Jeez. And did bring him back and he went back to work a few days later. Okay. He didn't publish his account,

Dr. Tosak didn't publish his account of this until 12 years later. Little suspect. So I don't know, there's some, the idea that you could do 45 minutes of, first of all, 45 minutes of mouth to mouth is a lot of mouth to mouth. A lot of mouth to mouth, yeah.

And the chances of that- I hope you at least got some dinner first. The chances of that being successful and the person not only coming back, but coming back completely intact are pretty slim. But anyway, the point is it did definitely reinvigorate interest in mouth to mouth resuscitation. Yeah, one more thing.

Let's do that instead of the whole fireplace bellows thing and then you don't have to find bellows, right? Right. Like, cause before you would have to go look for them. you don't have to find bellows, right? Like, cause before you would have to go look for them. You don't even find them. So this is cool. So we've kind of come around to, we have mouth to mouth resuscitation.

And certainly it was the easier thing to address when someone wasn't breathing than if their heart was not beating effectively. Because you have to have at least a teeny bit of medical training to know if that's happening. Nowadays, we use a monitor to look at a heart rhythm. You could use a stethoscope if you had one, but back then the best thing you had

was to feel for a pulse, which I know that can sound like a really easy thing, but if you haven't been trained and where all the pulses are and how to feel for them, it might be tough to know if someone has a pulse or not. It doesn't sound easy to me. I think that would be very hard. Which is why we don't encourage, even today,

we don't encourage laypeople to try to assess for a pulse. We just tell them they should do chest compressions because it can be hard to know. And even if you feel a pulse, does that mean that the heart is beating the way we need it to? I don't know. Not necessarily. So you can see where, as we start to move into the,

we're into the 1700s, the efforts to help people who have stopped breathing, start breathing again, sort of outpace getting the heart started, because it's the thing we can identify more clearly. So I wanna talk about kind of our first organized efforts to get people breathing. But before we do that, we gotta go to the billing department.

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Bye. Okay, Sydney, we're just getting organized, just getting ready to really crank on this thing. What are we doing? So in the 1700s, specifically 1767, we see kind of our first, like, this is cool, those are like the precursors to modern emergency medical services formed. The Society for the Recovery of Drowned Persons

is formed in Amsterdam. And the reason I think again that we're focusing on drowning is it's really easy to, I mean, you know, it's like they're in water. It's not hard to diagnose. Yes, that's true. Yeah, you can almost right away, you're gonna know for sure. They're in water and then you pulled them out of the water

and they're not breathing. That's easy. That's a slam dunk diagnosis right there. Right. And that's easier than a lot of the other reasons people's hearts stop. Like you can't, there would be no way as a lay person, I mean, even now you can't look at someone

and know they're having a heart attack, right? But if they've got like seaweed all over them and like the pop bottle rings, you know, like then you know they were just pulled out of the water and they have been drowning. Now I am going to guess, and this is not my area of expertise, but I am going to guess that the pop bottle rings

did not exist in 1767. Okay, yes, that is true. It would have been, I guess, tea bottle rings or perhaps ale bottle rings. Thank you Sydney Doesn't this predate plastic at this point? Interesting. We did use to use hemp to hold together. Yes, it was much more ecologically. Was that better for the ducks and turtles? The Pepsi and the Cokes and even the Coke Zeroes were tied together with a Hemp sort of material that was more ecologically sound. I know all you listeners out there

are my good pop bottle ring clippers, aren't ya? Yeah. We all saw those ads. They never left us. Yeah. Anyway, so the Society for the Recovery of Drowned Persons was the first- Which sounds like a group that is devoted to like, all right guys, listen,

we gotta get them out of here. Everyone's complaining about the look of it and the water is the same water we drank. We gotta recover these drowned persons and get them out of the water. It's gross. We've talked about it before. I mean, like the Timbs did get pretty rowdy

for a while there, so you never know. So they would recommend like, here are the things we have found to be the most helpful when it comes to if you've pulled somebody out of the water and they're apparently not breathing, how might you try to bring them back? Mouth to mouth was a key piece of that,

so breathing for them. Getting them warm was a big part of that. The idea of like trying to get the water back out of their lungs by like putting them head down, like trying to get them in a position where their head was down and sort of pushing on their stomachs to try to push the water back out was a big part of it.

And then they would do things, and this was happening all over the place, to stimulate them back to life, like rectal fumigation. Sorry, what? They would blow tobacco smoke up their butts. Literally blow the smoke up their butts. Yeah, literally blow the smoke up their butts. Literally blow smoke up their butts. Yeah, literally blow smoke up their butts.

I don't know, I mean, there are a number of ways you could fumigate. It doesn't have to be like shotgunning, but when I first read that, I thought like, like, that can't be right. Surely not that. It's man. If nothing else, the pressure alone wouldn't be enough.

I'm sorry, it's just the idea that you else, the pressure alone wouldn't be enough. I'm sorry. It's just the idea that you would like it's undignified enough you're already died in the river and then they get you out. Like the one final insult. To unigate their butts with tobacco smoke. Just on all fours, the whole town comes around to see them. Oh man. The human condition.

Yeah, indeed. It's difficult. Bloodletting was recommended for drowning just like everything else. That was not effective. I'm just going to go ahead and put my foot down on that one and say not effective. Now it was very supposedly very successful. They claim that they save 150 people in the first four years. That's a lot.

Not bad. That's a lot of people. That's more than me. And it led to other organizations being founded all over Europe, in Hamburg, in Venice, in Paris, in all kinds of places. People started to get on board with these different techniques,

and then the best place they would do presentations in churches. I think just as a place in the community where people gathered, they could stand up and read some like, hey, if you see someone drown, here's some stuff you can do. Which again, it makes sense if you're thinking about why would they start with drowning? Why the focus on drowning? Again, I think it's visible.

It can impact anyone. We didn't exactly have a lot of water safety at that point. Like I don't think... It's also notoriously difficult, I would think to study, right? Because you can only do it sort of retroactively. You don't know when this is gonna happen. And it seems pretty random as to where it could strike. It impacts the advancement of our understanding

of this area of medicine, even to this day. The fact that this isn't, I mean, a lot of times in medicine, we can, you know, we have people with some sort of chronic illness and we give one group one pill and one group the other pill and we see who does better and that kind of thing. Or we like can stimulate some kind of, or simulate some kind of condition in a lab and then we can test

the different responses. You can't really do an ethical study where you stop people's hearts intentionally and then see what the best way of bringing them back to life is. Right. Like, please don't do that. I'm not advocating for that.

Don't do that. And in the real world, if you come across this scenario, you have one shot to save your Uncle Dylan. I don't think that's gonna be the time where you're like trying to experiment on some new, wild new approaches that you've heard about. You probably just gonna go with what people have traditionally,

sort of like the childbirth thing that we talked about, right? Like, no, there's not enough research there because no one wants to research on their fetus. It's hard, cause if you have like, yeah, I mean, that's the truth. What medicines are safe in pregnancy, our list is still pretty short

because we don't want to test meds on pregnant people. We're still very reluctant to do that. I mean, and that makes sense. It's rough. Ethically, some of these areas get pretty rough. How do we advance our understanding so we can take better care of people? But we don't wanna do that

by putting other people in harm's way to gain that knowledge. That's a great challenge of medical science, I think. So anyway, along this same time, they're having the success in Amsterdam. You've got a physician in England, William Hawes, who is using some of these same methods, especially the tobacco smoke enemas.

People really liked that. And he has a reward out there for like, if you can bring me, like if you see somebody drowning and you can pull them out of the water quick enough and get them to my office. I'll give you half a crown. I'll pay you money. Which like, and this would lead to in England,

they started what they called the Society for the Recovery of Persons Apparently Drowned. They're hedging their bets a little bit there. They're not coming down all the way on like Society for the Recovery of Drowned Persons. They're saying that they're apparently drowned. We heard. You're getting into semantics, right?

Cause you're also saying, like I would argue that if someone's drowned, I feel like that's kind of it. Apparently drowned is like, I mean, it looks like they're drowned, but let's go ahead and try. Maybe they're just drowning. Yeah, exactly. It could be in progress.

That would eventually become the Royal Humane Society, Oh, interesting. which was sort of like the first EMS, you know, in England. And it would lead to other organizations that were based on that in other places. And they also started to explore the idea of like going to where people were. That was sort of the next step, right?

The beach. In a lot of these cases, it's if you can get the person who's drowned to the office of someone, then they'll do these things as opposed to, let's put people, let's get people out to the site of the drowning and try to do things

to bring them back there. Like that was a big shit. I know that sounds like a common sense thing, but it would take a while, right? It also would take medical professionals who are willing to go out into the community and do this stuff. And it also would take lay people being trained

in these methods, which is kind of like, it's interesting. Cause they all had to be kind of, everybody had to be kind of ready. Cause you never knew who was going to be the first person on the site. On a side note, I think it's worth mentioning that around the same time as we're kind of developing

different ways of breathing for people, we're doing a lot of experimentation as we move into the 1800s with like electricity and stuff. And it's cool because you see the first mention of using an electric shock to bring someone back. Oh yeah. With a chicken. And that is with a Danish physician,

Peter Christian Abelgaard, who he studied at medical school and then he was like studying pharmacy and then chemistry. And then he was selected to go join a medical school and then he was like studying pharmacy and then chemistry and then he was selected to go join in France to go join an effort to stop cattle disease. So he was like put in veterinary school. So like he just got to, I don't know, I don't know if he had any agency in any of this one way or another. He ended up as a veterinarian and he did these studies on like, if I shock a chicken's head, it dies.

But if I shock its chest, it sometimes comes back. And he allegedly did it to the same chicken over and over again and was like, look, I can bring him back every time. Believe it or not, I'm doing it, y'all. I keep bringing the chicken back and the chicken did so well that it laid an egg later. Sorry, haters.

Maybe in self-defense. I have a kid now. You can't shock me anymore. There's a life that depends on me. Anyway, some of the efforts that were being, as they were kind of like drilling down on, okay, we're bringing down people back, we're trying to breathe for people,

what are all the different ways we can do it? You see like all these different maneuvers invented by these different groups. There's one by Marshall Hall that becomes really popular for a while where you roll the person onto their stomach and then back onto their side and then onto their stomach and then onto their side. And you keep rolling them back and forth to try to mimic the action of breathing in and out.

And you do it at a rate of 16 times a minute. That's exhausting. That would be hard. There are some limitations to that. So then Sylvester comes along and introduces the Sylvester method, and he's like, okay, rolling people onto their stomachs and all this, this is too much, what if they're big? What if they're heavy and you're not strong? And you know, there's a lot of reasons why this might be tough.

Also, like, as you're rolling them back and forth, you need another person there to kind of support their face. Yeah, because they'll be smooshing right into the concrete. Exactly. So he had a method where you would raise the patient's arms up by the sides of their head and then extend them gently and steadily upwards and then forwards. And you're trying to like elevate the ribs to like pull air in.

So like they're the bellows. You're like opening and squishing them to try to get the air going. Cause then you would push their arms back down to their sides and make them breathe out. Well, that's what you're trying to do. They're not breathing, but this is what you're trying to do. You're trying to like make inspiration

and expiration happen. You're trying to make the person into the Ambu bag. And these would continue all throughout the 1800s. These methods would be debated and different groups would be trying different things. Because I mean, like at this point, we're into 1910. We're back to what we called the Schaeffer method where we would flip people back over onto their stomachs

and then just sort of pound in the middle of their back. So we're almost at chest compressions. We just got them upside down. But we're getting closer. It would be after all this, and so like, if you remember, way back in the early 1700s, we had mouth to mouth resuscitation happening. We went through all of these different methods

to come back around in the mid 1900s, we're talking polio years. Holy crap, that's so recent. To come back around to mouth to mouth resuscitation, taking back over from the Schaeffer method and the Sylvester and all these other things. And it was because there was a point where a bunch of machinery had stopped working and some anesthesiologists had to do something quickly

for polio victims who couldn't rely on iron lungs and things like that. And they found that breathing for them was the most effective way to keep them breathing. And so then they started pushing to bring back, like instead of all this stuff that we do, we should just do mouth to mouth resuscitation. And that's where you see, I mean,

but we're in like the 1950s before this is coming back around. I know, but again, it's kind of like you said, it's a hard thing to study. Somebody has to be dying to study it. So it's tough. Hard thing to change too. It doesn't, it's not as responsive as you would want it.

It moves at a slower pace, I think, with stuff like that. Absolutely. You finally see like chest compression starting to come back around. Again, we're in the middle of the 1900s before like you see it formalized as like bringing all this together. Chest compressions were really just, we know that like to get the heart beating,

we need to push on the heart, but then we're like, how fast, how many, how do we stop to breathe for them too, or do we just keep doing the chest compressions? That debate is happening. How deep, what is the force of the chest compressions? We're sort of like figuring out all that throughout the 1950s.

And then finally we get to a point where in the 60s, we're putting it all together. The researchers who were studying chest compressions and the researchers who were studying mouth to mouth resuscitation, they come together in a big conference. And in 1960, they say, okay, this is the, this is, we got the combo. We got it. We got the combo. And like I said, I'm not going to get into the entire history of defibrillation and shocking

people because that's an entire parallel history that is happening alongside all this stuff. I was figuring out how to do that safely and not just kill people, but also bring them back to life. But we finally see in the 1960s, what we would come to know as the ABCs, it was a much longer sort of algorithm for a while.

It was like, there was ABCD and it went down to, I mean, it went down to like I, there was a whole list of different things that you could do. And so for a while, the next big debate was, okay, we figured out a way to do CPR for now. It was the airway breathing circulation back then, which was a mixture of so many chest compressions mixed with rescue breaths. It may be the thing you've only been trained in.

If you haven't been trained in CPR in a while, that might be the thing you still think is right. It's not, go to a new class. But you might be familiar with what I'm talking about. But the next big thing was, should we teach it to lay people? Because initially all of the different like medical organizations,

the American Heart Organization and the Red Cross and everybody were very against that. With the idea being that they just can't, they won't be able to do it right, it's too complicated, it's too high risk. You can if you're doing, like we've talked about, if you're doing chest compressions, the right way you could break ribs.

Like this isn't something that is appropriate and we just need to focus on calling the appropriate EMS, get a rescue squad there, get someone there who can do what needs to be done. We can't just teach this stuff. The liability of teaching it to lay people is too high. Okay. And they did some studies even then like in 1966

where they tried to teach CPR to lay people and then like in 1966 where they tried to teach CPR to lay people and then like how did they do with it? And how much do they like if we look six months later like come in and demonstrate to us what you learned and the results Weren't great like people just didn't remember right which is tough if you're not Doing it. It's hard But eventually enough people made the point that like, one, if we simplify it, they cut out all those extra letters. And two, the more people we teach it to,

like it's the only way even knowing this makes sense. Because when someone collapses suddenly, what are the chances that you are in a hospital or close enough to one, or that an ambulance is right nearby? Right. You gotta have somebody there who, it's better than nothing, right?

Exactly. And so that's when they started making sort of videos and training people and came up with like the national guidelines for this is what CPR is and this is how we teach it to everyone. And like I said, nowadays, this has been since 2015, what we found is that focusing on the chest compressions is the most important thing.

Breathing typically is going to be secondary to that. And if you're going to forgo chest compressions for only breathing, it's going to be a medical professional who makes that call. Somebody, whether it's EMS has arrived and you've got a paramedic or an EMT who's there making that call, or you do have someone like me, like a doctor on scene, we might be able to make that, but you as the layperson performing CPR, focus on the chest compressions, is the most effective thing you can do.

But you'll hear that at the class you're gonna go take, and not from us. Not from us. We're just telling you for entertainment purposes. And then you can find out about the other things, like there are defibrillators out around the community. You might see them somewhere in public. They're labeled.

Little AED boxes. Exactly, and the nice thing about them is when you open them up, they talk you through what you're supposed to do. They literally tell you, here's where you put the pads on the chest, and then it will tell you, is this a heart rhythm that can be shocked?

Because not all heart rhythms benefit from being defibrillated, from being shocked. And then it will do it for you and tell you to get out of the way. And now things are changing even more because even with all that, all that that we have learned and all the hundreds of years we've studied this stuff, our outcomes from CPR are not great.

Yeah, you delight in mentioning this to me pretty frequently. I don't delight. It's, I think we get a really warped perception from media. TV and Madam Web. Madam Web specifically. Madam Web specifically makes it look like CPR always works. They kind of, she almost says it. She almost says, if you just do this.

This is like a power that she gives them. Like there's a scene where she teach, I can't talk about Madame Web on the internet anymore. I know, I can't, but like it's not just Madame Web. There are a lot of shows that give the impression that CPR is usually successful. The truth is the opposite. So when it comes to doing CPR outside of a hospital,

so out in the world somewhere where someone has collapsed, our success rates are like five to 10%. Sydney, it's such a bummer. One study suggested maybe it's as high as 12, but that's about it. Yeah, in the hospital, it's better, but still not great. It's like 20 to 25%.

Oh man. And that's just people that were able to get return of spontaneous circulation, meaning their heart is pumping blood on its own. Of those people that we resuscitate, only about 10% actually make it out back out of the hospital at some point. So like-

That's why we try to reinforce on Sawbones. It is so important to keep your heart from stopping in the first place. Like really you should try to keep it going if at all possible. And I know when you hear this, you think like, okay, but why in the world would I go do a CPR class if these are-

What I'm wondering over here. If this is as good as this intervention is. Well, one, the alternative is the, I mean like, the risk benefit ratio plays out here. Yeah. Five to 10% is better than 0%. Yeah. Two, obviously it's different depending on the situation.

And there are times like in a lot of the respiratory arrests that I take care of, I can, I mean, we're successful. I have been successful 100% of the time out in the field. Hey, there she goes, beating the odds. Well, I'm not. Everybody else is messing up her averages, right? Listen, the longer I do this work, I know I won't always be 100%.

But my point is there are many cases where you can intervene and save someone's life or keep someone alive until EMS gets there, help preserve brain tissue, other organs that need blood and oxygen. So like it is a useful thing to do. And the more we do these things, the better we get at them, the more we learn, which is why even now we have a new effort

to try something called ECMO. You may have heard of ECMO, extracorporeal membrane oxygenation. It's like a heart-lung machine. That's a simplified way of thinking of it. We have those in hospitals. We've used them in hospitals for a while. What if we put them in trucks that were mobile

and sent them out into the community? And if somebody's heart stopped, we could hook them up to an ECMO right there. The survival rates are so far looking to be better in the limited places where they're trying this intervention. Obviously it's very expensive, it's resource intensive. And some well-educated operators are what I'm asking. Right, this is not something you could teach laypeople.

This is something, I mean, I as a physician do not know how to hook someone up to ECMO. I could not do it. I would need to be specially trained and then you would need a lot of practice to make sure you were proficient at it. So this is not something we could train laypeople to do, but if we did have these mobile response units,

we maybe could save more lives. So maybe that is the next frontier where we actually start to get better and see those statistics look improved. But in the meantime, that's my last push, like check your community. You can probably check your local library. Libraries are great. They can tell you everything.

Where are CPR classes? I'm sure, you know what you could also do, there's this thing called the internet. Hey, there she goes. And I bet if you looked up CPR classes near me, it would tell you, I bet you. I bet you're 100% right. I forget about the internet sometimes because I love libraries so much.

That is gonna do it for us this week on Saw Bones. Thanks to the taxpayers for the use of their song, Medicines, as the intro in our Trevor program. And thanks to you for listening, we really appreciate it. That is gonna do it for this week. Until next time, my name is Justin McElroy. I'm Sydney McElroy. And as always, don't drill a hole in your head. Alright!