Pulmonary ventilation (and hence external respiration) is achieved through manual insufflation of the lungs either by the rescuer blowing into the patient's lungs, or by using a mechanical device to do so. This method of insufflation has been proved more effective than methods which involve mechanical manipulation of the patient's chest or arms, such as the Silvester method. It is also known as expired air resuscitation (EAR), expired air ventilation (EAV), rescue breathing, or colloquially the kiss of life. It was introduced as a life saving measure in 1950.