Shiber: The History of Resuscitative Medicine

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 1^st successful external compression
  • 1901 Igelsand 1^st successful open massage
  • 1904 Crile 1^st 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: 1^st use of ABC teaching
  • 1963 AHA endorses CPR
  • 1966 1^st 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 2^nd 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 1^st modern ICU: neurosurgical care
• 1953 Ibsen Copenhagen 1^st ICU for Polio using PPV
• 1958 Safar (Baltimore): 1^st 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.”