I think I first got the sense that Johns Hopkins was a really integral part of the
history of resuscitation when I was at Duke and I did one of my very first talks
on the history of resuscitation. And I found a very clean copy of the
article, it's very helpful for my talk,
then I came to Hopkins and I was giving another talk on the history of CPR
and came here to the stacks and this is what I found, this original copy of the
Kouwenhoven, Jude, and Knickerbocker paper and this brings tears to my eyes.
It's been handled so frequently and you can clearly see that at Hopkins it's
a really important part of our history.
Certainly the most impressive and important event was the publication of the
paper in JAMA, 50 years ago showing that in-patients for the first time if you
compress the chest in a regular rhythmic way you provide enough blood flow so that
you can go get a defibrillator and ultimately defibrillate a patient with
ventricular tachycardia fibrillation and save their life.
The history of CPR really involves five key gentlemen and that's Dr.
Kouwenhoven who is a retired Department Chair of Engineering who started the lab and Dr.
Blalock's Department of Surgery. He had a young Guy Knickerbocker,
working with him and they were trying to discover how to defribrillate through the chest.
And as they were becoming successful with this they made this observation - that
pressing on the chest with these paddles may in fact raise the blood pressure.
When they put the paddles on the guy noticed that there was an increase.
He put the paddles on each side of the chest he noticed that there was an
increase in blood pressure.
And rather than just ignoring that because that's not what they were funded to do he
was curious about that and he followed up on that and they started as a team to
think about if pressing on the chest might actually profuse the organs and that led
to this famous moment about the elevator story that I've discovered when I was
talking to them where Dr. Knickerbocker apparently was working in the lab one day
and this dog was not supposed to have a cardiac arrest at that moment and it did
and they wanted to save the dog but they knew they needed electricity because that
was the part of the research they did know and they knew that they needed to apply
the electricity within five minutes or‬ the ‪dog would die. And so he asked his colleague to press on
the chest, what we now call chest compressions.
He didn't know what it would do but he said "Just keep pressing, I'll be back"
and he literally ran down the stairs from the 12th floor of what's now called
Blalock and he went all the way down to 5. I made my way down pretty fast down the
stairwell, down to the heart station, got the defibrillator, rolled it to the
elevator, pushed the button, and waited. Anybody that knows the Blalock elevators
knows that you have to wait and wait and he did and he doesn't know but he thinks
it was close to 20 minutes and he finally gets upstairs and they're still pressing
on the chest and really the dog should not revive because they've never had a dog
live more than six minutes. And he applies the defibrillator, the dog
immediately revives, and the next day he's completely back to himself.
And that was there A-ha moment, it's not what their research was supposed to be but
they discovered that just compressions perfuses the heart and as he says it slows
the dying process and gives you a chance to get them back.
So Dr. Jude who was working down the hallway on some other research started
talking to him about this and he was an actual physician who was able to translate this.
He was able to take this lab work into the actual clinical environment and save
lives clinically. I think at the same time as we were doing
this with the cardiac the mouth to mouth resuscitation was being done at the
Baltimore City Hospital by Peter Safar and James Elam that's why you have the
pulmonary in CPR otherwise it would just be CR.
There's a story that Fire Chief McMahon had been invited to the Peter Safar's lab
and shown how to do mouth to mouth to patients in the real world who'd had for
instance a drowning and then he was also invited over to the cardiac arrest lab
and shown this chest compression component and we understand that they met and that's how
this concept of CPR came together. It's a classic story from Johns Hopkins.
There are people from anesthesia, from surgery, from engineering all working
together and coming up with this key concept of CPR and helping us save lives
and here we are 50 years later.
The American Heart and American Red Cross have been instrumental in advocating that
the public should do and perform CPR and in training the public to do CPR the next
logical step was to produce a device that would be easy for the public to use to
actually definitively provide defibrillation.
So in the mid-1990s industry decided to produce these devices and the American
Heart Association promoted the notion that these should be applied and tested in the
public theater. There were several studies that showed
very clearly you could have a lay person defibrillate and have the person survive.
And then the National Heart, Lung, and Blood Institute sponsored a randomized
clinical trial in public sites that was published in the New England Journal of
Medicine about six years ago that showed that if you compare sites with people,
volunteers who were trained at defibrillators and had a defibrillator
there was better survival than in sites where they just called 911 and did CPR.
It does go back to Jude, Kouwenhoven, and Knickerbocker and Knickerbocker's interest
in defibrillation and I can assure you that guy Knickerbocker or Kouwenhoven
never conceived of the idea back then that a lay person would actually do this
definitive job of giving a definitive shock to a patient in order to cure their
cardiac arrest. See this is the next advance in CPR
because this is basically like a big blood pressure cup, this is a bladder, and then
this is an inflation system here.
Unfortunately the overall survival rate of the 250,000 people who have a cardiac
arrest today is only 8%, only 8% of those people survive to leave the hospital alive
with reasonable neurologic function so there's a lot that we hope we can do to
improve the way we do CPR, the frequency and the technique, and bring in new
and exciting ideas to improve outcomes. Here at Hopkins we're trying to take the
classic teaching of CPR but move it into the next generation.
Sure, we want you to learn CPR on your knees in case somebody drops in front of
you at the airport but we also want you to learn to work in a team of 10 to 15 people.
We think the simulation lab is making it much more realistic, helping them
understand how to put it all together better than the kind of classic curriculum.
In the last few years the most important addition in my view to routine CPR
and this issue of defibrillation is the use of in-hospital hypothermia.
What we've learned from CPR and resuscitation is that we can
restart organs and organ systems after they failed.
With the recent success in therapeutic hypothermia it's almost like a suspended
animation state to limit the injury of the brain, the heart, and every organs of the
body but the next step here which is even more crucial in my mind is to figure out
how the brain restarts and how do we protect that mechanism.
After an injury or even during sleep the cortex needs to be awakened so there's an
alarm system here that comes out from the sub-cortical area.
With therapeutic hypothermia what it does is it allows us to protect many aspects of
this and that's what we're trying to do in my laboratory.
It is up to future researchers and current researchers to actually find the most
appropriate means to channel this discovery to actually create and establish
the best possible outcome in patients. So it may not be therapeutic hypothermia,
it may be something else in the near future, but in principle we already have
proof that the brain can recover to a certain degree and it is up to the future
work to allow us to make the brain - to facilitate the brain recovery to where it
was before cardiac arrest. So it's a technique that took off 50 years
ago which has been exploited extensively the last 50 years and has made a major
impact on human health.