Doctors say CPR helped save Damar Hamlin's life. Here's how CPR came to be

Editor's note: This article is a part of a series reviewing Utah and U.S. history for KSL.com's Historic section.

SALT LAKE CITY — The sports world was rocked this week when Monday's NFL contest between the Cincinnati Bengals and Buffalo Bills ended after Bills safety Damar Hamlin suffered cardiac arrest and collapsed on the field shortly after a tackle.

Miraculously, after initially being listed in critical condition and on a ventilator Monday night, Hamlin has since woken up and was able to communicate to his doctors, family and teammates by Friday, the team tweeted.

Doctors at the University of Cincinnati Medical Center said Thursday that Hamlin still has a long recovery but they credit the quick action of training staff on the field, performing CPR early after Hamlin collapsed.

"It just speaks really to the immediate recognition that there was something significantly and seriously wrong by the Bills medical staff. We cannot credit their team enough," Dr. William Knight IV told WLWT in Cincinnati. "There are injuries occasionally that happen on sports fields but it is incredibly rare to have something be this serious and to be that quickly recognized."

Sports Illustrated reported Thursday that Bills assistant athletic trainer Denny Kellington is the one who stepped in quickly and performed CPR, resuscitating Hamlin on the field. Bills head coach Sean McDermott called Kellington "a real hero in saving Damar's life."

The incident has also prompted medical professionals from across the country to remind everyone about the importance of learning how to perform CPR or how to use automated external defibrillators, more commonly known as AEDs.

"Recovery and outcome (are) improved if you receive CPR in under three minutes," said Dr. Richard Ferguson, the chief medical officer for Health Choice Utah, in an appearance on KSL NewsRadio's "Dave and Dujanovic" on Tuesday. "Survivability is much higher if under three minutes. If it goes over three minutes, we're looking at, often sometimes, (a) 5% survival rate."

But have you ever wondered how we got the modern form of CPR that's used today?

How CPR came to be

People have had the desire to resuscitate others in need for centuries; however, without the advancement of science, many of the earliest methods weren't anywhere as reliable as CPR. There are many interesting and even outlandish practices that were used at one time or another but here's a short history of the development of modern methods.

There were a couple of early theories on how to resuscitate someone, Steve Berry wrote for the Journal of Emergency Medical Services.

First, there was the heat method. Early civilizations noticed that a lifeless body became cold so they believed sprinkling warm ashes on a body would help restore life. There was also the flagellation method, where someone would be whipped with the hope that they would wake up.

Yet what's used today essentially started with the Bellows Method developed by Swiss physician Paracelsus in 1530, the American Heart Association notes. This method involved using fireplace bellows to try and resuscitate someone.

"Victims had hot air or smoke from the bellows of a fireplace forcefully blown into their sealed mouth — also known as a BBQ BVM (bellows vomit metabolizer)," Berry wrote.

This continued to be the primary method for quite some time. Berry added that the fumigation method came about in 1711, which focused on "propelling tobacco smoke up the lifeless victim's rectum." That was also a common practice for a while.

Some more modern practices also came out of the 18th century, too. In 1732, Scottish surgeon William Tossach tried mouth-to-mouth breaths in an effect to save a miner who was suffocating, the American Heart Association wrote. It was the first documentation of this method. Danish veterinarian Peter Abildgaard, in 1775, found that a countershock to a chicken's chest "could restore a heartbeat," the organization added.

John Hill, of the Royal Free Hospital, would later write what "could equally be a present-day description of external cardiac massage" in 1868, Raymond Hurt wrote for the Journal of the Royal Society of Medicine.

After a handful of cases involving animals proved to be successful, Dr. Friedrich Maass used external compressions "to restart the hearts of two young human patients" in 1891. Maass became the first major advocate of this practice, the American Heart Association added.

Still, it would take quite some time for other medical professionals to agree. There were several other developments that advanced the science after Maass; however, CPR — as we know it today — really originates 63 years ago.

In 1960, Drs. William Kouwenhoven, Peter Safara and James Jude combined new advancements in mouth-to-mouth breathing techniques with chest compressions, the association noted. It wrote that the "forerunner" of general public CPR training also began that year.

The American Heart Association would formally endorse CPR for the first time in 1963. And as the understanding of the human body only grows with time, the practice has changed to make it as effective as possible.

Kouwenhoven is also credited with developing the first external and portable defibrillator. It helped Arch Diack, W. Stanley Welborn and Robert Rullman develop the modern-day AED in 1978, according to a history compiled by the medical supply company AED Leader.

Learning CPR today

The American Heart Association says that 350,000 Americans die every year from cardiac arrest. That number can be lowered through CPR, which is why its development through time is so vital.

One issue, however, is not many people know how to perform it. One 2015 survey found two-thirds of 9,022 respondents reported having learned CPR at one point but only 18% were currently trained, according to a study published in the Journal of the American Heart Association.

Per the American Heart Association, there are two common ways to perform CPR:

• There's the 30:2 ratio, which calls for two mouth-to-mouth breaths for every 30 compressions. For adult victims, rescuers are advised to perform chest compressions at a rate of 100 to 120 compressions per minute at a depth of 2 to 2.4 inches. This method is advised for health care professionals and others who are currently CPR certified.
• For those who aren't trained, compression-only CPR is advised. That means 100 to 120 compressions per minute without any mouth-to-mouth breaths. The organization recommends that a person call 911 first and then perform CPR until help arrives.

The organization also has an online tool that allows people to find a class to become certified.

All of this comes back to Monday's incident. Ferguson said the main takeaway from Hamlin's story is the importance of emergency first aid and learning CPR in times of need. It can make all the difference.

"If someone in your room right now or in your family doesn't know CPR, they should learn it," he said. "Because this is the only thing that led to (Hamlin) leaving that field with a pulse. And if this did not happen on 'Monday Night Football,' live television with doctors and paramedics and an ambulance at the ready, the outcome would have been far, far worse."

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