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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
Thank You for Your Attention
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