Shiber: The History of Resuscitative Medicine

We are excited to welcome back Dr. Joseph R. Shiber, Associate Professor of Emergency Medicine at the University of Florida College of Medicine. Dr. Shiber is currently on loan to us here at the University of Maryland as he completes his Critical Care Medicine Fellowship. He is the first EM/IM/CCM graduate our program ever had and has been making waves in the academic world since his departure. After many requests he has agreed to share one of his most requested lectures: A brief history of resuscitative medicine. This lecture is simply fascinating to hear the origins of some of the things we take for granted every day. I assure you this will be 45 minutes well invested!

Clinical Pearls (assisted by Lino Rafael O. Trinidad)

Historical Perspective

  • Basic understanding of physiology
    • Started with yelling at patient, slapping faces, water, fumigation, natural chemicals
      • Remnants: precordial thump, NH4 inhalant
  • Early Resuscitation Techniques for drowning:
    • BC Egypt: inversion techniques
    • 1800s: barrel rolling and horse trotting (early compressions?)
  • First Organized Effort to Respond to Sudden Death (Amsterdam 1767): “Society for the recovery of Drowned Persons”
    • Warming, elevate feet above head, abdominal pressure to clear aspirated water, respirations via bellows, tickling throat, fumigation with smoke
      • Many of which influenced modern techniques
  • London Royal Humane Society (1865): Recommendations for “nearly dead” drowning patients:
    • Take to nearest house, dry and warm, clear nose and mouth, rub skin briskly, pass volatile salts under nose

Airway

  • 1540 Vesalius inserted reed into trachea on animals proving “artificial airways
  • ETT:
    • 1871 Trendelenberg cuffed tracheostomy tube
    • 1889 Head cuffed ET tube
  • 1895 Kristen laryngoscope (previously: direct visualization and digital placement of ETT)

Breathing

  • Old Testament references mouth to mouth
    • Hebrew midwives used for centuries
  • 1500s Parcellus used bellows in nose/mouth
  • 1732 Tossach used MTM to resuscitate coal miner
    • MTM disappeared for 200 yrs with discovery of O2
  • Silvester Method 1861
    • Arm lift with chest/abd compressions
  • Elam and Safar– Rescue Breathing
    • Open airway: chin lift and jaw thrust
    • Ventilated residents and students under curare
      • Published JAMA 1958
      • Endorsed by Red Cross 1960

Circulation: Compressions

  • Distant History:
    • 1628 Harvey finger stimulation of dove hearts
    • 1874 Schiff open “cardiac massage” in dogs
    • 1878 Boehm external compressions in cats
    • 1891 Maass 1st successful external compression
    • 1901 Igelsand 1st successful open massage
    • 1904 Crile 1st use of IV saline, epi, and MAST suit
  • External chest compressions on dogs:  Kouwenhoven, Knickerbocker, Jude
    • Published 1960 JAMA
  • CPR
    • 1960 Maryland Medical Society Meeting
    • 1962 film Pulse of Life: 1st use of ABC teaching
    • 1963 AHA endorses CPR
    • 1966 1st CPR guidelines published
  • Defibrillation
    • 1775 Abildgald showed electricity in birds could stun and then revive
    • 1889 Prevost and Batelli showed that shock induces VF in dogs then 2nd countershock can reverse it
    • 1947 Beck: internal defib “hearts too good to die”
    • 1956 Zoll external defib (AC power)
    • 1962 Lown DC power: safer, more effective, portable, smaller

Development of ICU

  • 1854 Florence Nightingale established first “monitoring unit” for injured soldiers during Crimean War
  • 1863 small room leading to OR (post-op patient care)
  • 1890 Tarnier in Paris: infant incubator and first NICU/PICU
  • 1923 Dandy JHH 1st modern ICU: neurosurgical care
  • 1953 Ibsen Copenhagen 1st ICU for Polio using PPV
  • 1958 Safar (Baltimore): 1st ICU w/ 24-hour coverage
  • 1960’s: ICUs for s/p open heart and post-MI; STC

It helps to know our past as we move forward.

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

Suggested Reading

  1. U.S. National Library of Medicine [Link]
  2. American Association for the History of Medicine [Link]
  3. Safar S. On the history of modern resuscitation. Crit Care Med. 1996 Feb;24(2 Suppl):S3-11 [Pubmed Link]
About the Author

Jim Lantry

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Just your average critical care doc: Wandering the ED and ICUs for the USAF down in the San Antonio Military Medical Center, traveling the globe to cannulate for ECLS wherever the need arises, and trying to keep up with great minds of today. E: JlantryMD@gmail.com

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