The Thump of Life

For the person whose heart stops suddenly and unexpectedly, the best places in the U.S. to be this winter are Baltimore and Washington, Albuquerque and Rockford, Ill. This has nothing to do with geography or climate or the overall quality of medical care in those widely separated cities. It is because ambulances and hospitals there are equipped with a relatively simple and highly portable device that seems to be the best thing yet for prompt and effective resuscitation.

Mouth to Mouth. The Heart-Lung Resuscitator, or HLR, which doctors have dubbed "the Thumper," works on the twin principles that a person whose heart stops must have both his breathing and his circulation restored. Most older methods of resuscitation, such as medieval flagellation or jackknifing the victim over a fence, have been barbarous and useless. Others have been of limited value because they concentrated on only one phase of the problem: breathing. Even the best of these methods, mouth-to-mouth breathing, went out of fashion in the Victorian era because it seemed not quite nice, and it took U.S. doctors years to restore it to favor after World War II.

The next step was to combine mouth-to-mouth resuscitation with external heart massage. A Johns Hopkins team did this in 1959, when it devised a system in which one rescuer does the mouth-to-mouth work while another puts his hands on the lower part of the victim's breastbone and presses down smartly, 60 to 80 times a minute, to restart the heart. All Baltimore fire and emergency crews use this method, and it has saved many lives.

Squeeze the Heart. But doctors still wanted something more automatic and reliable. Working with engineers of Massachusetts' Brunswick Manufacturing Co., they devised the Thumper, which is basically a small (1 1/2 in. by 3 in.) pneumatic plunger strapped to the chest (see cut). Powered entirely by compressed oxygen (small tanks in portable units, bigger ones in hospitals), the HLR supplies a puff of oxygen twelve times a minute through a face mask, while the plunger, which replaces the rescuer's hands, bounces up and down on the victim's breastbone 60 times a minute. On the downstroke it compresses the chest and squeezes the heart against the spine, forcing blood out. The heart relaxes and refills on the upstroke.

Ideally, the victim of sudden heart arrest should get immediate mouth-to-mouth breathing by one rescuer and simultaneous chest massage by another, until the Thumper arrives, to do both jobs precisely and tirelessly all the way to a hospital. Within hospitals themselves, HLRs are expected to be useful in emergency rooms and intensive-care units, where seriously ill patients are especially subject to heart stoppage.

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