The idea was that pumping on the chest moved blood out of the heart to the vital organs and breathing into the mouth got oxygen into the lungs.Once help arrived, or the patient was taken to the hospital, a defibrillator used an electric shock to return the heart to normal rhythm.

“We thought we'd figured out how it worked,”says Robert A.Berg, MD, a professor of pediatrics at the University of Arizona and a member of the CPR research lab. But then it became apparent that there was more to be learned. "More of the same isn't going to be good enough," Dr. Berg says. “We have to have new ideas.”

Since then, some of the best new ideas have come from the University of Arizona Health Sciences Center, where the CPR laboratory has risen to and remains at the forefront with a core of doctors and researchers continuously looking for ways to improve CPR.

“This center is a major center of CPR research,” says Art Sanders, MD, a UA professor of surgery and a member of the lab.

Drawing from a multitude of disciplines, including cardiology, surgery and emergency medicine, the lab examines every link in the “chain of survival”: recognizing the emergency and calling for help; beginning CPR; defibrillation; and advanced care, usually by paramedics, which can include drugs and breathing tubes. UA researchers also have examined CPR inside hospitals, and how even health professionals can improve resuscitation efforts.

Evidence of the lab's influence can be found in the most recent CPR standards issued by the American Heart Association. The former guidelines stated that in two-rescuer CPR there should be one breath after every five compressions. The newest guidelines call for one breath after every 15 compressions, maximizing the amount of time blood is being forced through the body.

The lab also boasts having one of the few people in the world to be named a “CPR Giant” by the American Heart Association. The honor, given by the AHA's Emergency Cardiovascular Care Committee, recognizes the many contributions that Gordon A. Ewy, MD, chief of cardiology at the UA and director of the UA Sarver Heart Center, has made to the field.

The lab's approaches have tended toward the practical. One example is a kind of metronome that members crafted to help people keep the 100-pumps-a-minute pace recommended for chest compressions. Another is a tool commonly used in anesthesia that the members borrowed for CPR when they realized it offered a valuable way to measure the effectiveness of CPR as it is being performed.

“We're learning that it's more complex than just pushing on the heart,” Dr. Berg says.

One of the more profound questions the lab is asking is how to get more people to perform CPR. The rates of bystander CPR have fallen in recent years, which translates into thousands of lost lives.

One possible answer the researchers are considering is simplifying CPR by eliminating ventilation when it is performed on adults. It takes several minutes for oxygenation levels to fall after the heart stops, but every second that the heart isn't pumping means the organs are being deprived of blood.

Studies undertaken by CPR research lab members and other researchers seem to point toward chest compressions as a good compromise for people uncomfortable with the prospect of touching lips with a stranger.

In a recent study, people who were taught either standard CPR or chest-compressions-only were asked to demonstrate what they had learned on a dummy.

Even though the situation was pretend, the standard CPR group paused for an average of 63 seconds before beginning. The chest-compressions-only group paused an average of 30 seconds.

“The people in the first group were so bludgeoned with information that they were paralyzed,” says Karl B. Kern, MD, associate director of the Cardiac Catheterization Laboratory at University Medical Center and coordinator of the Sarver Heart Center's CPR research group.

The conclusion: the less people have to do, the better they'll do.

Plus, data indicate that survival rates for standard CPR and chest-compressions-only are about the same.

“If you will breathe, and you can breathe, you should breathe,” he advises. But if you're unwilling, at least perform chest compressions.

“Doing something is so much better than doing nothing.”