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The Art of Providing Resuscitation in Greek Mythology

Siempos, Ilias I. MD*†‡; Ntaidou, Theodora K. MD; Samonis, George MD§

doi: 10.1213/ANE.0000000000000416
Critical Care, Trauma, And Resuscitation: Special Article

BACKGROUND: We reviewed Greek mythology to accumulate tales of resuscitation and we explored whether these tales could be viewed as indirect evidence that ancient Greeks considered resuscitation strategies similar to those currently used.

METHODS: Three compendia of Greek mythology: The Routledge Handbook of Greek Mythology, The Greek Myths by Robert Graves, and Greek Mythology by Ioannis Kakridis were used to find potentially relevant narratives.

RESULTS: Thirteen myths that may suggest resuscitation (including 1 case of autoresuscitation) were identified. Methods to attempt mythological resuscitation included use of hands (which may correlate with basic life support procedures), a kiss on the mouth (similar to mouth-to-mouth resuscitation), application of burning torches (which might recall contemporary use of external defibrillators), and administration of drugs (a possible analogy to advanced life support procedures). A careful assessment of relevant myths demonstrated that interpretations other than medical might be more credible.

CONCLUSIONS: Although several narratives of Greek mythology might suggest modern resuscitation techniques, they do not clearly indicate that ancient Greeks presaged scientific methods of resuscitation. Nevertheless, these elegant tales reflect humankind’s optimism that a dying human might be restored to life if the appropriate procedures were implemented. Without this optimism, scientific improvement in the field of resuscitation might not have been achieved.

From the *Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, University of Athens Medical School, Athens, Greece; Division of Pulmonary and Critical Care Medicine, Department of Medicine, New York-Presbyterian Hospital-Weill Cornell Medical Center, Weill Cornell Medical College, New York, New York; and §Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece.

Accepted for publication July 11, 2014.

Funding: None.

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Address correspondence to Ilias I. Siempos, MD, Division of Pulmonary and Critical Care Medicine, Department of Medicine, New York-Presbyterian Hospital-Weill Cornell Medical Center, Weill Cornell Medical College, 1300 York Ave., New York, NY 10065. Address e-mail to isiempos@yahoo.com.

For ancient Greeks, the Upperworld (symbolizing life) was distinct from the Underworld (symbolizing death). The ruler of the first was the mighty Zeus, whereas the governor of the other was Hades, brother of Zeus.1 These 2 worlds were well separated. Once the souls of mortals left the Upperworld to enter the Underworld, through the river Acheron, which was located in Epirus (northwestern Greece), there was no way back. Charon, the strict ferryman who guided the souls during their passage of Acheron, and mainly Kerberos (Cerberus), the 3-headed watchdog of the Underworld, prevented them from returning to life.2 Death was considered irreversible.

However, apart from the river Acheron, there were a few additional ways down to the Underworld; namely, Cape Taenarus and Elis in the south and west Peloponnese, respectively, as well as Eleusis near Athens. Thus, in Greek tradition, there was the possibility of free communication between Upper (life)- and Under (death)-worlds. Interestingly, several heroes (including Heracles [Hercules] and Orpheus) exploited those passages to move between the 2 worlds to bring deceased persons back to life. In other myths, revival of the dead was achieved without the need of such a journey. If mythological resuscitation is viewed as a parallel to actual resuscitation in the modern sense, then this concept was not totally absent from the minds of ancient Greeks. Yet, scholarly works tracing the roots of resuscitation have not explored the ancient Greek tradition.3,4

Keeping the above in mind (and with a lively imagination), we reviewed the literature of Greek mythology to identify myths that might foreshadow modern resuscitation. We then compared the methods of resuscitation described in the myths with those used in modern practice. Finally, by surveying several scholarly interpretations of myths, we examined whether such methods might indicate an otherwise unknown medical practice of ancient Greeks in the field of resuscitation.

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METHODS

Greek myths potentially dealing with resuscitation were identified in 3 well-respected compendia of mythology. Two authors systematically searched The Routledge Handbook of Greek Mythology (a revised version of H.J. Rose’s classic Handbook of Greek Mythology),5 The Greek Myths by Robert Graves,6 and the 5-volume Greek Mythology by Ioannis Kakridis (a reference book in the Greek literature).7

By exploring the 3 abovementioned anthologies,5–7 we initially located potentially relevant tales. If necessary, a Web site dedicated to Greek mythology was accessed to obtain additional information (www.theoi.com; accessed May 1, 2014). We then examined the original sources where these tales were mentioned. Several classical works, including the epics of Homer, the poems of Hesiod, the tragedies of Euripides, and the masterpieces of Latin scholars (such as Ovid), were reviewed. After studying the original sources of a myth, a definitive decision was made whether the myth could be considered suggestive of resuscitation. In most cases, the same myth was retold in different ways by successive authors; in such cases, we studied all available versions of the same myth but presented only the ones that were close to our subject.

After deciding which myths were suggestive of resuscitation, we selected and further analyzed the ones with parallels to modern resuscitation practice. To this end, both the modern practice (in brief) and the representative myth (in detail) were presented together to help the reader identify the links (if any) between them. Each representative myth was then analyzed with references from other scholars to conclude whether the myth may indicate a scientific method of resuscitation.

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RESULTS

Thirteen mythical accounts were identified as suggestive of resuscitation. Mythological resuscitation was provided using hands (which may correlate with basic life support procedures), a kiss on the mouth (similar to mouth-to-mouth resuscitation), using burning torches (which might recall contemporary use of external defibrillators), administering drugs (a possible analogy to advanced life support procedures), and physical stimulation in 3, 1, 1, 2, and 2 tales, respectively (Table 1). In 3 myths, the method of resuscitation was not specified. Finally, an interesting case of autoresuscitation (involving Sisyphus, King of Corinth in southern Greece) was found (Table 1).

Table 1

Table 1

Of the 13 identified myths, the 4 most promising are presented in detail and analyzed below.

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Resuscitation Provided by Using Hands

Modern Practice

Recent guidelines on cardiopulmonary resuscitation (CPR) emphasize the effect of uninterrupted high-quality (i.e., of appropriate rate and depth) chest compressions on the survival of victims experiencing cardiac arrest.8 All bystanders are encouraged to provide chest compressions, even without accompanying rescue breaths (if untrained or unwilling to do so); chest-compression-only CPR is better than no CPR in arrests of cardiac origin.9 By using their hands to perform chest compressions, rescuers retain a small (albeit critical) blood flow to the brain and heart, optimizing the effectiveness of a subsequent external defibrillation.8

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Representative Myth

The most famous hero in Greek mythology, Heracles, used his hands to revive Alcestis, wife of Admetus. The latter, King of Pherae in Thessaly (central Greece), was known for his hospitality, a highly valued attitude in Greek tradition. Admetus had once generously hosted Apollo, god of light. Apollo repaid the honor by convincing Moirai (Fates, personifications of destiny) to reprieve Admetus from his fated day of death if someone else would agree to die in his place. When the day arrived for Admetus to die, nobody wanted to replace him, not even his aged parents. Only Alcestis stepped forward and sacrificed herself. Although disconsolate at the loss of such a devoted wife, Admetus did not omit his hospitality duties toward Heracles, who incidentally arrived in Pherae at the same time. Once Heracles was informed about Admetus’ predicament, he wrestled with Thanatos (personification of death) and brought Alcestis back to life.10 The exciting struggle of Heracles with Thanatos for the rescue of Alcestis inspired Euripides (5th century BC) to write a tragedy10 and has been depicted in several art pieces (Fig. 1).

Figure 1

Figure 1

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Analysis of the Myth

In the myth, Heracles restores Alcestis to life without touching her.10 He uses his hands only to fight with Thanatos. There is nothing to suggest external pressure applied to the thorax of the heroine, that is, a scientific technique used successfully for the first time by Friedrich Maass in 1892.3 Thus, the myth of Alcestis does not clearly refer to modern use of CPR.

If a medical explanation seems improbable, what could this myth mean? One could note that ancient Greeks, gifted with vivid imagination, personified both their gods and concepts (including death) to provide reasons for whatever good or bad was happening to them. Once a god or concept takes a physical existence, it might also be easier to handle. Specifically, since death was personified as Thanatos (having a physical body), it then became possible for an exceptional human (Heracles) to wrestle and eventually defeat him.

Interestingly, in the initial version of the myth, Alcestis was restored to life by Persephone, goddess of the Underworld.11 However, in the later version of the myth, adopted by Euripides, it was a human (not a goddess) who provided resuscitation.10 This shift may reflect the self-confidence and optimism of the Athenians of the classical period that even humans could acquire the skills to provide effective resuscitation.

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Resuscitation Provided by a Kiss on the Mouth

Modern Practice

Although high-quality chest compressions alone may be sufficient shortly after nonasphyxial cardiac arrest, provision of oxygen to the victim is eventually needed.8 Accordingly, the combination of chest compressions with ventilation (either mouth-to-mouth or bag-mask ventilation) is recommended for CPR.8 During ventilation, each rescue breath should be of adequate duration (approximately 1 second) and volume (so that the chest of the victim rises).8

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Representative Myth

In his Metamorphoses, Apuleius (2nd century AD) described the tale of Eros (Cupid) and Psyche,12 which inspired many painters, including Anthony van Dyck (17th century) and Jacques-Louis David (18th century). According to the tale, Psyche was a princess who became famous because of her extraordinary beauty. The popularity of Psyche raised the jealousy of Aphrodite (Venus, goddess of beauty), who sent her son, Eros, to humiliate her. Eros, however, fell in love with Psyche and met her every night, until Aphrodite captured Psyche and terminated their romance. The goddess forced the princess to accomplish several tasks to prove her love for her son. Among others, Psyche had to go to the Underworld to bring the vessel (pyxis) where Persephone kept her cosmetics and jewelry. Psyche performed the trial, but, being curious, she opened the vessel and immediately fell into a death-like sleep (an incident that recalls anesthesia).13 Fortunately, Eros missed Psyche and began to look for her. When he found the almost-dead mistress, he revived her by pricking her with an arrow or by kissing her on the mouth. The revival of Psyche through a kiss on the mouth has been depicted in art as early as the 2nd century AD (contemporaneous to the Apuleius’ narrative), as indicated by the sculpture Cupid and Psyche that is exhibited in the Capitoline Museums in Rome, Italy. This revival scene, which was also depicted by Antonio Canova (Psyche Revived by Cupid’s Kiss; 18th century), can be viewed as an elegant artistic example of mouth-to-mouth resuscitation.

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Analysis of the Myth

In the myth, although the rescuer places his mouth on the mouth of the victim, he does not blow air. Thus, there is no application of the modern resuscitation technique of positive pressure ventilation like that used in 1732 by William Tossach, who revived a man by blowing his breath into the victim’s mouth “as strong as he could.”14 Rather, the technique (mouth-to-mouth placement without expired air ventilation) used in the myth of Psyche may remind us of the one used by the prophet Elisha in the Old Testament,3,15 which is commonly (yet mistakenly) described as an example of mouth-to-mouth resuscitation.16

The kiss on the mouth that awakens a princess from a death-like long-lasting sleep recalls the 19th century folk tale “Little Briar Rose” by the Brothers Grimm, a precursor of the popular “Sleeping Beauty” fairytale.17 Such a kiss may not symbolize resuscitation but rather a declaration of love.17

Interestingly, in some versions of the myth, Eros revives Psyche by pricking her with an arrow, that is, by applying a painful stimulus. Historically, physical stimulation (even slapping or hitting) of the body of the victim has been a widespread resuscitation method up to the 20th century.4

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Resuscitation Provided by Using Burning Torches

Modern Practice

Since its first successful application in 1955 by Paul Zoll on a man with recurrent syncope,3 external defibrillation has been established as an intervention to treat cardiac arrest due to ventricular tachycardia/fibrillation.18 Electricity is used to restore coordinated activity of the myocardium and facilitate return of spontaneous circulation. Automated external defibrillators and manual defibrillators are key components of basic life support and advanced life support guidelines.18

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Representative Myth

According to Lycophron (3rd century BC), when the monstrous Scylla was slain by Heracles, her father restored her to life by applying flaming torches to her body.19 Such a technique may parallel the use of external defibrillators. Scylla was once a beautiful nymph admired by Glaucus, who, in turn, was loved by the sorceress Circe. While Scylla was taking her bath, her jealous rival Circe poured a magic potion into the water so that the maiden transformed into a monster. The scene of change of Scylla was described vividly by Ovid (1st century AD)20 and painted by Peter Paul Rubens (16th century). Scylla lived on one side of the Strait of Messina, between Italy and Sicily, and another hideous creature, Charybdis, lived on the other side. Both attacked passing ships, so sailors attempting to avoid Charybdis would approach Scylla and vice versa. This tale has survived in the modern idiom as “between Scylla and Charybdis,” which describes a situation in which avoidance of one danger leads inescapably to exposure to another.

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Analysis of the Myth

The myth refers to fire instead of electricity (which was discovered in the 18th century), and, thus, its link with modern resuscitation is tenuous.

The use of flaming torches as a means to provide resuscitation is not surprising, because fire was highly valued by ancient Greeks who considered it a precious gift to humankind stolen from the gods by the titan Prometheus. For this humane act, Prometheus was tortured by Zeus; namely, he was nailed to Mount Caucasus, while an eagle devoured his liver every day.21 Such a sacred gift of divine origin could restore life as well.

Historically, early humans used heat during their resuscitation attempts.4 Restoration of body warmth was pursued by placing warm ashes, burning excrement, bottles of hot water, or heated bricks directly on the body of the victim.4 Such heat resuscitation methods were applied up to the 19th century.4

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Resuscitation Provided by Administering Drugs

Modern Practice

Although their importance is only secondary to high-quality chest compressions and early defibrillation, drugs are included among advanced life support procedures.22 Drugs used for resuscitation include adrenaline, amiodarone, and possibly vasopressin.23 In principle, drugs should not be administered before the initiation of chest compressions, ventilation, and defibrillation (if indicated).22

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Representative Myth

The diviner Polyeidus revived Glaucus, son of king Minos of Crete (an island in southern Greece). According to the story, one day the young Glaucus suddenly disappeared in his father’s palace. Minos summoned Polyeidus, who was acclaimed for his clairvoyance, to assist in the search. Polyeidus observed that an owl was driving bees away from a wine cellar and eventually found the boy drowned in a vat of honey inside the cellar. Minos then locked the seer in a tomb along with the deceased child and a sword and commanded him to bring Glaucus back to life (Fig. 2). While in the tomb, Polyeidus used the sword to kill a snake that crawled toward the corpse. However, a second snake appeared with an herb and restored the first serpent to life. Polyeidus then used this herb to revive the child.24

Figure 2

Figure 2

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Analysis of the Myth

In the myth, Polyeidus managed to revive Glaucus (who was dead for several hours) by using only an herb. However, drug administration without preceding chest compressions is not recommended by current guidelines.22 In addition, scholars believe that the herb used by Polyeidus was mistletoe, to which magical rather than therapeutic properties have been attributed.6 Thus, the myth does not clearly refer to a scientific method of resuscitation.

However, the myth of a boy who “died” after falling in a vat of honey but eventually recovered may still be subject to a medical interpretation if the unresponsive state is viewed as a coma instead of death. Indeed, a modern physician might recognize a case of hyperglycemic coma reversed by the administration of the appropriate treatment (insulin, in our days). In his work On Incredible Tales, Palaephatus (probably 4th century BC) provided such an explanation of the myth.7 He assumed that Glaucus lost his senses after consuming honey and that Polyeidus used an herb to reverse this unresponsive state.7

Several interpretations (other than medical) of various elements of the Polyeidus myth have also been pursued.6,7 In some, an owl (a nocturnal bird) symbolized death, while honey was a known embalming fluid in ancient Crete (where jar burials of infants were found).6,7 In addition, the snake was considered a prominent symbol of revival, possibly due to the yearly sloughing of its skin.6,7 Serpents were also connected with 2 other mythical figures, Erichthonius and Asclepius,6,7 who also had the ability to raise the dead using the blood of Medusa. Erichthonius was depicted as half-man and half-snake, while Asclepius wielded a snake-entwined rod, which is a dominant symbol for professional health care associations.

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DISCUSSION

We reviewed intriguing narratives, which derive from the Greek mythology and address resuscitation themes. We had initially hypothesized that ancient Greeks could have had knowledge of scientific resuscitation procedures that was later incorporated into myths. After carefully assessing the myths, we inferred that such a hypothesis, albeit attractive, was not plausible because interpretations of myths other than medical ones were more credible. The presented narratives should be viewed primarily as examples of fantasy on concepts that later led to scientific developments.

We do not preclude that relevant tales (i.e., suggestive of resuscitation) could also be found in the mythology of important civilizations other than Western civilization. For example, the demigod Gilgamesh, the central character in Mesopotamian mythology (ca. 2500 BC), also accomplished a trip to the Underworld just like the Greek heroes.25 However, we chose to present Greek myths, which we view as a part of the world’s (not only Greek) cultural heritage.

Our contribution has several limitations. First, although our review of the literature of Greek mythology was systematic, we are aware that classical literature does not easily lend itself to this sort of analysis. An initial exploratory attempt to implement a conventional search strategy was not fruitful; that is, an electronic search in PubMed (up to December 2013), with broad search terms (resuscitation AND myth*), without any limit, yielded only 48 reports, of which only 1 was relevant.26

Second, the relevance or the connection between some of the abovementioned myths and resuscitation might be questioned. Indeed, some of them may seem less convincing than others. We believe that in general there are no serious mismatches between the presented mythical accounts and resuscitation. Ultimately, we rely on the imagination of the reader to accept the connection.

Third, historical medical writings would be more appropriate than myths to inform as to whether ancient Greeks had indeed glimpsed scientific resuscitation methods. However, to the best of our knowledge, such compelling evidence does not exist; thus, we sought relevant indirect indications in mythical accounts. Finally, although we strived to present several scholarly interpretations of representative myths, we are mindful that other insightful explanations may be missed.

A common aphorism states: “in every myth, there is a grain of truth.” The grain of truth in the abovementioned elegant myths may not be an otherwise unknown medical practice of ancient Greeks (as we initially hoped). Rather, it could be the strong desire of humankind that a dying human might be restored to life if the appropriate procedures are implemented. Without this desire, which is vividly expressed in myths suggestive of resuscitation, many of the resuscitation techniques currently used may not have been achieved.

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DISCLOSURES

Name: Ilias I. Siempos, MD.

Contribution: This author conceived of the study, designed the study, performed the literature search, selected the appropriate myths, and wrote the first draft of the manuscript.

Attestation: Ilias I. Siempos read the manuscript and approved the submission.

Name: Theodora K. Ntaidou, MD.

Contribution: This author performed the literature search, selected the appropriate myths, and revised the manuscript for important intellectual content.

Attestation: Theodora K. Ntaidou read the manuscript and approved the submission.

Name: George Samonis, MD.

Contribution: This author selected the appropriate myths and revised the manuscript for important intellectual content.

Attestation: George Samonis read the manuscript and approved the submission.

This manuscript was handled by: Avery Tung, MD.

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REFERENCES

1. Capps E, Page TE, Rouse WHD. Apollodorus, The Library, 1.2. The Loeb Classical Library. Apollodorus. The Library I. 19211st ed New York G.P. Putnam’s Sons:10–1 In:
2. Page TE, Rouse WHD. Hesiod, Theogony, 310–2. The Loeb Classical Library. Hesiod. 19141st ed New York The Macmillan Co:100–2 In:
3. Cooper JA, Cooper JD, Cooper JM. Cardiopulmonary resuscitation: history, current practice, and future direction. Circulation. 2006;114:2839–49
4. Liss HP. A history of resuscitation. Ann Emerg Med. 1986;15:65–72
5. Hard R The Routledge Handbook of Greek Mythology: Based on H.J. Rose’s “Handbook of Greek Mythology.”. 20041st ed New York Routledge
6. Graves R The Greek Myths. 1992Complete Edition London Penguin Books
7. Kakridis I Greek Mythology. 19865 volumes. 1st ed Athens Ekdotike Athenon
8. Koster RW, Baubin MA, Bossaert LL, Caballero A, Cassan P, Castrén M, Granja C, Handley AJ, Monsieurs KG, Perkins GD, Raffay V, Sandroni C. European Resuscitation Council Guidelines for Resuscitation 2010 Section 2. Adult basic life support and use of automated external defibrillators. Resuscitation. 2010;81:1277–92
9. SOS-KANTO Study Group. . Cardiopulmonary resuscitation by bystanders with chest compression only (SOS-KANTO): an observational study. Lancet. 2007;369:920–6
10. Page TE, Rouse WHD. Euripides, Alcestis, 1142–4. The Loeb Classical Library. Euripides IV. 1912;5041st ed New York The Macmillan Co In:
11. Jowett B. Plato, Symposium, 179c. The Dialogues of Plato. 1892;5493rd ed London Oxford University Press In:
12. Capps E, Page TE, Rouse WHD. Apuleius, Metamorphoses, vi.22. The Loeb Classical Library. Apuleius. The Golden Ass. 1922;2793rd ed New York G.P. Putnam’s Sons In:
13. Ntaidou TK, Siempos II. The art of providing anaesthesia in Greek mythology. Anaesth Intensive Care. 2012;40 Suppl 1:22–7
14. Tossach WA. A man dead in appearance recovered by distending the lungs with air. Med Essays Observations. 1744;5:605
15. DeBard ML. The history of cardiopulmonary resuscitation. Ann Emerg Med. 1980;9:273–5
16. Trubuhovich RV. History of mouth-to-mouth rescue breathing. Part 1. Crit Care Resusc. 2005;7:257
17. Hogstad G Archetypal interpretation of “Sleeping Beauty”: awakening the power of love. Mythological Studies Journal 2011; 2. Available at: http://journals.sfu.ca/pgi/index.php/pacificamyth/article/view/29/69. Accessed May 3, 2014
18. Deakin CD, Nolan JP, Sunde K, Koster RW. European Resuscitation Council Guidelines for Resuscitation 2010 Section 3. Electrical therapies: automated external defibrillators, defibrillation, cardioversion and pacing. Resuscitation. 2010;81:1293–304
19. Capps E, Page TE, Rouse WHD. Lycophron, Alexandra, 44–8. The Loeb Classical Library. Callimachus-Lycophron-Aratus. 19211st ed New York G.P. Putnam’s Sons:498–9 In:
20. Capps E, Page TE, Rouse WHD. Ovid, Metamorphoses, 13.729–925. The Loeb Classical Library. Ovid. Metamorphoses II. 19161st ed New York G.P. Putnam’s Sons:280–93 In:
21. Power C, Rasko JE. Whither prometheus’ liver? Greek myth and the science of regeneration. Ann Intern Med. 2008;149:421–6
22. Deakin CD, Nolan JP, Soar J, Sunde K, Koster RW, Smith GB, Perkins GD. European Resuscitation Council Guidelines for Resuscitation 2010 Section 4. Adult advanced life support. Resuscitation. 2010;81:1305–52
23. Mentzelopoulos SD, Zakynthinos SG, Siempos I, Malachias S, Ulmer H, Wenzel V. Vasopressin for cardiac arrest: meta-analysis of randomized controlled trials. Resuscitation. 2012;83:32–9
24. Capps E, Page TE, Rouse WHD. Apollodorus, The Library, 3.3. The Loeb Classical Library. Apollodorus. The Library I. 19211st ed New York G.P. Putnam’s Sons:310–3 In:
25. George AR The Babylonian Gilgamesh Epic: Introduction, Critical Edition and Cuneiform Texts. 2003;2 volumes1st ed London Oxford University Press
26. Papageorgiou E. Origins of cardiopulmonary resuscitation. Death, life and resuscitation in ancient Greek religion. Resuscitation. 1995;30:177–8
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