The modern era of resuscitation began in 1960 with the publication of the classic paper by Jude, Kouwenhoven, and Knickerbocker on closed chest cardiac compression, which showed that the circulation could be maintained during cardiac arrest without the need for thoracotomy.
A few years earlier Elam, Safar, and Gordon had established expired air ventilation as the most effective method for providing artificial ventilation for a patient who had stopped breathing.
The effectiveness of closed chest defibrillation had been demonstrated by Zoll a few years earlier. By combining the techniques of chest compression with expired air ventilation, it became possible to maintain the viability of a patient in cardiopulmonary arrest until a defibrillator could be brought to the scene.
Special units were established that were able to resuscitate patients at high risk of developing cardiac arrest, and special hospital cardiac arrest teams were created.
After coronary care units were established for patients with acute myocardial infarction, it became apparent that most deaths from the condition occurred in the early stages, not because the myocardium was severely damaged, but because of potentially treatable disturbances in the cardiac rhythm.
Once the effectiveness of resuscitation in hospital was established, the realization that two thirds of deaths from coronary heart disease occurred before hospital admission led to attempts to provide coronary care, and particularly defibrillation, in the community.
The credit for this development goes to Partridge in Belfast, who pioneered the first mobile coronary care unit staffed by a doctor and nurse.
This early experience confirmed the high incidence of lethal arrhythmias at the onset of myocardial infarction and many patients attended by the mobile units were successfully resuscitated from cardiac arrest.
Pentridge and his coworkers also drew attention to the value of cardiopulmonary resuscitation (CPR) performed by bystanders before the arrival of the mobile unit.
