How Did You Die?

A Glance at the Sometimes Gruesome Roots of CPR

“How did you die?”

In this 1950 educational film by The Beck Heart Foundation, a burly host was asking this simple question to a panel of eleven men and women. This was before CPR became a household term , before “Resuscitation Annie” was invented, and before Automatic External Defibrillators (AEDs) became ubiquitous in airports, malls, and hospitals.

The film, titled “The Choir of the Dead,” begins with a shot of the sharply dressed group neatly arranged in two rows like, well, a choir. In the background, a deep and somber voice introduces the ensemble :

“This is the choir of the dead. Death was reversed in these victims by resuscitative measures which included mouth-to-mouth respiration, bagged respiration, cardiac massage, and in some instances, defibrillation. They are alive years later with the same heart. “

As the camera panned across the survivors’ faces, the narration continued:

“The death factor is mobile. It can be moved around. It can be delayed or prevented in a good heart. It can be erased, as though it never occurred.”

Right on cue the host moves in and asks each person how he or she died. The answer  was always either cardiac standstill or ventricular fibrillation. The man conducting the rather morbid interview was Dr. Claude Beck: a Harvard and Johns Hopkins-trained neurosurgeon who then turned to cardiovascular surgery at Cleveland’s Western Reserve University School of Medicine. During his career he would pioneer techniques to improve cardiac circulation and developed an early defibrillator.

His motivation for working on resuscitation techniques was triggered by a jarring experience during medical training.  Beck was assisting a senior physician in surgery, when their patient suddenly went into cardiac arrest.  To Beck’s surprise, the surgeon walked over to the phone and called the fire department.  The firefighters arrived with a Pulmotor, a device designed for mining accident and drowning victims to ventilate the lungs. The patient did not survive.

Years later, Beck got the chance to do much better. Among the eleven ‘choir’ members assembled for the 1950 educational film was Richard Heyard. In 1947, when Heyard was 14 years old, he was undergoing surgery for a chest deformity when his heart stopped.  Beck happened to be the surgeon. Beck quickly re-opened Heyard’s chest and began a prolonged resuscitation effort that lasted more than an hour. The team used a prototype defibrillator that Beck had designed, in combination with direct cardiac massage and medications. After about an hour and a half, Heyard’s heart began to beat on its own. He survived, becoming the first patient to be successfully resuscitated using a defibrillator. Beck later published this landmark event in an article for the New England Journal of Medicine.

Dr. Paul Zoll recalled the impact of Beck’s work in the 1950s.  In Allen Weisse’s book “Heart to Heart”, Zoll described physicians carrying knives at all times in case someone collapsed in cardiac arrest. The response would have been to splay the chest open and start direct cardiac massage. Medical residents were warned not to wear neck ties that may be inadvertently cut off in the flurry of a resuscitation effort.

Back to the film, the screen now shows a sign proclaiming:

“The heart attack kills many people whose hearts are too good to die.”

When one of the survivors asked Beck what he envisioned should happen when someone suffered a cardiac arrest outside the hospital. Beck responded with a near-perfect prediction of what has become common practice today:

“Well, I think people will have to learn how to circulate the blood by squeezing the chest without opening the chest. They will have to learn how to blow the lungs up by mouth-to-mouth breathing, and they have to ask for help. And then help will come, and professional personnel, doctors, can defibrillate the heart or help get it started. I visualize this program to become very widespread over the entire world.”

The American Heart Association estimates that 70 percent of out-of-hospital cardiac arrests occur in the home, making CPR a critical skill for the household. A lay person who is faced with the task of performing CPR is thus more likely to perform it on a loved one.  A study in 2009 showed that even children as young as 9 years old can effectively learn basic life support skills including how to use an AED. More importantly, this contention has been proven by real world accounts such as the boy who saved his sister who fell in a swimming pool, or the boys who helped saved an infant by telling the mother how to correctly perform chest compressions on a baby.

Thankfully, modern educational materials are not as morbid as “The Choir of the Dead,” and Beck’s vision of a widespread program has come true, enabling the lay public to potentially save a person from cardiac arrest – no knives required.

The film may be viewed here.