1. The History of Resuscitation
Joseph Shiber, MD, FACEP, FACP, FCCM
UF College of Medicine - Jacksonville

2. Outline
Early conceptions and techniques
Airway
Breathing
Compressions
Defibrillation
ICU development

3. “I heard of an Egyptian that had
nine hours lien dead, who was by
good appliances recover’d”
Shakespeare – Pericles Act 3, Scene 2

4. Historical Perspective
O Recognized “almost dead” vs “very dead”
O Didn’t understand physiology
O Tried to wake up person who looked
asleep
O Yelling, slapping/beating, water,
fumigation
O Remnants: Precordial Thump, NH4
Inhalant

5. Early Resuscitation Techniques
O BC Egypt: Inversion for drowning
O Barrel rolling and horse trotting into 1800’s

6. Jiu Jutsu Books 1600’s: Kappo

7. 1st Organized Effort to Respond to
Sudden Death
o Amsterdam 1767
Society for the Recovery of Drowned Persons
1. Warming
2. Elevate feet above head
3. Abdominal pressure to clear aspirated water
4. Respirations via bellows
5. Tickling the throat
6. Fumigation with smoke

8. London 1788

9. London Royal Humane Society
O 1865 recommendations for nearly dead
1. Take to nearest house
2. Dry and warm
3. Clear nose and mouth
4. Rub skin briskly
5. Pass volatile salts under nose
6. Admit no more persons into room than
absolutely necessary

10. Airway
O 1540 Vesalius inserted reed into trachea
O 1871 Trendelenberg cuffed tracheostomy
tube
O 1889 Head cuffed endotracheal tube
O 1895 Kristen laryngoscope

11. Breathing
o Old Testament references to Mouth-to-Mouth
o Hebrew midwives used for centuries
o 1500’s Parcellus used bellows in nose/mouth
o 1732 Tossach used MTM resuscitate coal
miner
o Disappeared for 200 yrs: discovery of Oxygen

12. Silvester Method 1861

13. Modern Era (?) 1900’s

14. Elam & Safar: Rescue Breathing
O Open airway: chin lift and jaw thrust
O Ventilated residents and students under
curare
O Published JAMA 1958
O Endorsed by Red Cross 1960

16. Circulation: Compressions
O 1628 Harvey finger stimulation dove hearts
O 1874 Schiff open “cardiac massage” in dogs
O 1878 Boehm external compressions in cats
O 1891 Maass 1st successful external compression
(not widely appreciated by medical community)
O 1901 Igelsand 1st successful open massage
O 1904 Crile 1st use of IV saline, Epi, MAST suit

17. 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

18. 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

19. Defibrillation
O 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

20. Defibrillation
O 1947 Beck internal defib “hearts too good to die”
O 1956 Zoll external defib
O Initial units A-C line 110v; transformer
boost>500v
O 1962 Lown D-C safer & more effective
battery to charge capacitor
smaller and portable

21. Putting it together: CPR
O 1960 Maryland Medical Society Meeting
O “Two techniques complete approach to
resuscitation”
O 1962 film Pulse of Life: 1st use of ABC teaching
O 1963 AHA endorses CPR (as it is now called)
O 1966 1st CPR guidelines published

22. 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

23. 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

24. Summary
O Long history of attempting to reverse sudden
death or near death events
O 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

25. “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.”

26. Questions & Comments
Thank You for Your Attention