The History of Resuscitation

Joseph Shiber, MD, FACEP, FACP, FCCM

UF College of Medicine - Jacksonville

Outline

Early conceptions and techniquesAirwayBreathingCompressionsDefibrillationICU development

“I heard of an Egyptian that had nine hours lien dead, who was by good appliances recover’d”

Shakespeare – Pericles Act 3, Scene 2

Historical PerspectiveO Recognized “almost dead” vs “very

dead”O Didn’t understand physiologyO Tried to wake up person who looked

asleepO Yelling, slapping/beating, water,

fumigationO Remnants: Precordial Thump, NH4

Inhalant

Early Resuscitation Techniques

O BC Egypt: Inversion for drowningO Barrel rolling and horse trotting into

1800’s

Jiu Jutsu Books 1600’s: Kappo

1st Organized Effort to Respond to Sudden Deatho Amsterdam 1767Society for the Recovery of Drowned Persons1. Warming2. Elevate feet above head3. Abdominal pressure to clear aspirated

water4. Respirations via bellows5. Tickling the throat6. Fumigation with smoke

London 1788

London Royal Humane Society

O 1865 recommendations for nearly dead 1. Take to nearest house2. Dry and warm3. Clear nose and mouth4. Rub skin briskly5. Pass volatile salts under nose6. Admit no more persons into room

than absolutely necessary

AirwayO 1540 Vesalius inserted reed into

tracheaO 1871 Trendelenberg cuffed

tracheostomy tubeO 1889 Head cuffed endotracheal tubeO 1895 Kristen laryngoscope

Breathingo Old Testament references to Mouth-to-Moutho Hebrew midwives used for centurieso 1500’s Parcellus used bellows in nose/moutho 1732 Tossach used MTM resuscitate coal minero Disappeared for 200 yrs: discovery of Oxygen

Silvester Method 1861

Modern Era (?) 1900’s

Elam & Safar: Rescue Breathing O Open airway: chin lift and jaw thrustO Ventilated residents and students

under curareO Published JAMA 1958O Endorsed by Red Cross 1960

Circulation: Compressions

O 1628 Harvey finger stimulation dove hearts

O 1874 Schiff open “cardiac massage” in dogs

O 1878 Boehm external compressions in catsO 1891 Maass 1st successful external

compression (not widely appreciated by medical community)

O 1901 Igelsand 1st successful open massageO 1904 Crile 1st use of IV saline, Epi, MAST

suit

Circulation: Compressions

“The surgeon’s left hand was placed firmly across the front of the chest, the fingers resting over the fifth, Sixth, and seventh cartilages on the right side, while the tip

of the thumb lay on the second piece of the sternum and the muscular part of the hand on the corresponding

cartilages on the left side. The right hand now crossed over the left and forcible pressure made; the hands then being suddenly removed, the chest was allowed to expand by its own elasticity.” John Hill - 1868

Kouwenhoven, Knickerbocker, Jude

O Working on external defib but re-discovered external compressions

O Didn’t discuss MTM since patients intubated in OR

O Published 1960 JAMA

DefibrillationO 1775 Abildgald electricity in birds could

stun and then revive but didn’t know heart involved

O 1889 Prevost & Batelli shock induce VF in dogs then 2nd “countershock” could reverse it

DefibrillationO 1947 Beck internal defib “hearts too good

to die”O 1956 Zoll external defibO Initial units A-C line 110v; transformer

boost>500vO 1962 Lown D-C safer & more effective

battery to charge capacitor smaller and portable

Putting it together: CPR

O 1960 Maryland Medical Society MeetingO “Two techniques complete approach to

resuscitation”O 1962 film Pulse of Life: 1st use of ABC

teachingO 1963 AHA endorses CPR (as it is now called)O 1966 1st CPR guidelines published

Development of the ICU

O 1854 Florence Nightingale 1st “monitoring unit” near RN station for most seriously ill/injured soldiers

O 1863 “small room leading to OR where pt remains until recovered from immediate effects of operation”

O 1890 Tarnier in Paris: infant incubator & 1st NICU/PICU

O 1923 Dandy JHH 1st modern ICU: neurosurgical care

Development of the ICU

O 1953 Ibsen Copenhagen 1st ICU for Polio patients PPV by bagging using MS’s instead NPV

O 1958 Safar Baltimore 1st ICU w/ 24hr MD coverage

O 1960s: ICUs for s/p open-heart patients & s/p MI since needed to be near immobile defibrillator

O R Adams Cowley Baltimore Shock-Trauma

SummaryO Long history of attempting to reverse

sudden death or near death eventsO Do not think we ever “know how to do

it now” O We are getting better by studying

resuscitation O It helps to know our past as we move

forward

“Believe those who are seeking the truth; doubt those who find it."

“Once in a while you will stumble upon the truth but most of us manage to pick ourselves up and hurry along as if nothing had happened.”

Questions & Comments

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