Brain death starts to occur four to six minutes after someone experiences cardiac arrest. Up until the mid-20th century, even if you were rushed to a nearby medical facility, doctors would cut open your chest and try to manually restart the heart, a procedure with very low success rates. However, with the advent of CPR, first endorsed by the American Medical Association (AMA) in 1958, the survival rate for victims of cardiac arrest more than doubled. Today, thanks to the training of millions of Americans in CPR, up to half of all victims receive CPR before professional help arrives, a wide-scale effort that has helped save millions of lives.

What did it take to equip bystanders around the world with life-saving skills? The earliest attempts to explore interventions for sudden cardiac arrest date back to Dutch canal rescues in the mid-18th century. By 1957, with the help of a $10,000 Army grant ($90,000 in 2017 dollars), Baltimore physician Peter Safar, working with Buffalo doctor John Elam, had codified and conclusively demonstrated the effectiveness of modern mouth-to-mouth resuscitation. Their method won endorsement the next year from the AMA. They next joined forces with Dr. William Kouwenhoven of Johns Hopkins Hospital to add chest compressions to their method, and, after advocating for years, in 1966 won the backing of the National Academy of Science for what we call CPR today. While Safar and colleagues were developing the practice, another physician on the opposite side of the Atlantic had been working on how to proliferate it.

In 1966, Dr. Frank Pantridge, with modest funding from the British Heart Foundation, rolled out the first mobile coronary care unit in Belfast, Northern Ireland—taking CPR to the patient rather than confining it to the hospital. Within five years, a handful of individuals led shifts toward paramedic-staffed (rather than physician-staffed) units. In 1968, hospitals in the United States began to follow suit. A breakthrough in diffusion came when Dr. Leonard Cobb of Seattle in 1970 received major funding ($2.85 million in 2017 dollars) from the Washington/Alaska Regional Medical Program to begin training non-medical personnel in CPR, starting with city firefighters.

Cobb soon realized that the methods could be spread to the general public. When the regional medical program reduced its grants, individual contributions and the Rotary Foundation kept training afloat, and within a few years they had trained 100,000 ordinary citizens in Seattle. By 1981 the training effort included 9-1-1 dispatchers, who could, in turn, coach callers. Building on Cobb’s success, other cities followed suit, and the American Red Cross and American Heart Association (AHA)—two of the largest and most influential nonprofits in the country—began using their considerable reach to train millions of Americans in CPR and millions more around the globe. The AHA today has a network of 4,000 training centers worldwide. In the United States, even though 88 percent of out-of-hospital cardiac arrests occur in the home, today 32 to 46 percent of those who suffer an out-of-hospital cardiac arrest now receive some sort of CPR or first aid before professional help arrives. 

Researched and written by Consultant Phil Dearing of The Bridgespan Group, based on Bridgespan interviews with Leonard Cobb, retired physician and founder of Medic One; Jonathan Epstein, senior director of science and content development at the American Red Cross; Catherine Barry, national director of aquatics at the American Red Cross; and Marie Manning, director of ECC marketing communications at the American Heart Association, as well as selected sources.

Selected Sources