In Reply Dr Shiber references the early literature of cardiopulmonary resuscitation. There were indeed several descriptions of maneuvers that were similar to closed-chest compression as practiced today. Some of these early techniques were in fact designed to help ventilate the lungs rather than circulate blood.1 The 1960 article by Kouwenhoven et al2 was the first human clinical application based on animal experimentation with unequivocal utility in a prospectively observed case series. It was a landmark study3 and in a very short time dramatically changed the management of cardiac arrest.
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