The modern face of CPR – Resusci Annie

The modern face of CPR – Resusci Annie

Adapted from an article entitled ‘The face of CPR’, written by Stephanie Loke, a dental core trainee year 2, and Sarah McKernon, clinical lecturer/specialist in oral surgery at the University of Liverpool. The article appeared in BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m3899 (Published 10 December 2020); and featuring on https://www.labnews.co.uk/article/2031026/a-christmas-tale-for-resusci-annie

Thanks to Stephanie and Sarah for permission to cite their work.

The story behind Rescue Annie involves a drowned woman, a pathologist and a toy maker…

It seems strange that for a manikin that is familiar to many people who have done first aid and Cardio Pulmonary Resuscitation (CPR) training, nobody knows who the real model for Resusci Annie was, what was her life story, what her real name was, her age or her background.

But when her lifeless body was pulled from the River Seine river in 1865, the girl who became known as L'Inconnue de la Seine, i.e. ‘the unknown woman of the Seine’ became part of an amazing story. While she did not live to tell us the tale of her life, she has transformed training for medical emergencies and saved many lives. Hers is the face that we recognise as the model used for cardiopulmonary resuscitation (CPR) during first aid sessions. But have you ever stopped and wondered about who she was and how she became the face of modern CPR training?

The mysterious death, of ‘L'Inconnue de la Seine’, ‘the unknown woman of the Seine’...

When the body of a beautiful young girl was pulled from the River Seine in Paris in 1865, no one knew who she was. From her youthful appearance, she was thought to be about 16 years of age.

Following the normal practice at the time, her lifeless body was transported to a local mortuary where she was placed on public display in an effort to find out who she was. Despite this, no one came forward to identify her.

Her beauty was so striking that the pathologist who performed her autopsy arranged for a wax plaster mask of her face to be made. In the following years, her image was used in artwork and it was widely replicated, with copies being sold throughout France.

Who was she?...

Many theories and stories have been told about the origins of the drowned girl but in truth no one knows the true story about her life and demise. It was a long held belief that the girl died by suicide, as her body showed no evidence of violence. Others argued that she had been murdered; while another story described her as a young woman who was seduced by a lover, who took her own life when she fell pregnant and he abandoned her. In another story she was said to be one of a pair of identical English twins who had supposedly eloped to Paris with a wealthy suitor. Her whereabouts were unknown until her twin sister visited Paris and was shocked to see a mask that looked like a reflection of herself – she recognised the face as that of her long lost twin.

However, we still do not know which story is real and so her true identity still remains a mystery!

How did she become ‘Resusci Annie’?...

In 1954, an American physician, Dr James Elam, was the first to demonstrate that Cardio Pulmonary Resuscitation (CPR) was a sound technique, by showing that mouth-to-mouth breathing could maintain blood oxygen levels in a person who was not breathing. His studies led to the development of what we now know as the ‘ABC’ in the well-known First Aid Primary Survey that is known by the Acronym ‘DRSABCD’, i.e. A for airway, B for breathing and C for circulation (now regarded as C for CPR). In 1956 he met an Austrian anaesthetist, Dr Peter Safar, and while subsequently working together they demonstrated CPR’s superiority to other methods of resuscitation that were currently in use.

Meanwhile, Dr Archer Gordon, who was a founding member of the American Heart Association’s CPR committee, recognised that students practising CPR on each another risked causing injuries such as rib fractures as well as considerable pain. He and a Norwegian anaesthetist, Bjorn Lind, searched for a manufacturer of toys and dolls who could develop a lifelike manikin for safely practising CPR on. Working together with toymaker Åsmund Laerdal, they developed an entire line of manikins, and in 1960 the family ‘Resusci’ was introduced: Resusci Annie, Resusci Andy, and Resusci Baby, each being physically correct for their gender and size.

By applying steady, rhythmic pressure on their breastbones, and practising mouth-to-mouth breathing on these manikins, many first aid students have been taught, and practised, these lifesaving skills: how to save the lives of people who have had heart attacks, as well as on victims of drowning, choking, electric shock and drug overdose.

While thinking about what face he wanted to use on the adult female manikin, Laerdal remembered seeing a mask that was displayed on the wall of his grandparents’ house. It was a copy of that unknown drowning victim, and so he decided to use her enigmatic face on the new Resusci Annie CPR training manikin. Laerdal thought a female doll would be less intimidating for students learning CPR techniques. The manikin was made of polyvinyl chloride, PVC, which was a relatively new type of plastic material. To make her as realistic as possible she had full sized adult dimensions, a collapsible chest for practising compressions, and her lips were parted to enable students to simulate mouth-to-mouth resuscitation.

Annie’s legacy...

Since her first arrival in 1960, Resusci Annie has helped millions of people to learn and practise their CPR skills in resuscitation training rooms around the world, resulting in helping to save many people’s lives. Thanks to those intrepid doctors and an innovative toymaker, this unfortunate young girl , 'L'Inconnue de la Seine', has gone on from being an unknown 19th century drowning victim to becoming the face of modern CPR! I’m sure she would have been proud, as would her family, if only they had known!