Closed-chest cardiac massage

For much of the 1950s, reviving an arrested heart meant opening the chest. Surgeons performed a thoracotomy, massaged the heart by hand and placed defibrillator paddles directly on it. Claude Beck reported the first successful defibrillation of a human heart in 1947, through an open chest, and Paul Zoll reported defibrillation through the closed chest in 1956.

William B. Kouwenhoven, an electrical engineer at Johns Hopkins University, had studied the effects of electricity on the heart since the early 1930s, in collaborative projects with the medical faculty paid for by power companies. External compression itself was not new. Rudolph Boehm had restored circulation in cats with it in 1877, George Crile had done the same in dogs in 1903 and later described its use in people, and in 1954 Turk and Glenn at Yale reported 42 human cases. None of this work had caught on.

On July 9, 1960, Kouwenhoven, J. R. Jude and G. G. Knickerbocker published 'Closed-chest cardiac massage' in the Journal of the American Medical Association. The technique replaced thoracotomy and hand massage of the heart with compression through the intact chest wall.

Peter Safar had developed mouth-to-mouth breathing in 1957. Joined with chest compression, the combination was called cardiopulmonary resuscitation, or CPR, and a 2025 review in JACC: Basic to Translational Science credits Kouwenhoven, Safar and Jude with introducing it in 1960, when advances in ventilation and defibrillation made the combination practical. External chest compression with mask ventilation became the standard treatment for cardiac arrest inside and outside the hospital.