History of Resuscitation

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One of the most overlooked areas of medicine has traditionally been the area of resuscitation. In the age of evidence-based medicine, where it is assumed most major questions have been studied, and guidelines and protocols are well established, it is useful to reflect on the history of resuscitation. Early attempts at resuscitation were efforts to stave off death and maladies caused by everyday dangers including trauma, drowning, and asphyxiation. As Dr Peter Safar1 wrote, “The history of resuscitation medicine is inseparable from the history of medicine in general. We and future generations of resuscitation researchers should learn from history to avoid reinventing the wheel, proving the obvious over and over again, and missing clues for potential break-throughs.” For example, during the First World War, knowledge of ventilation, cardiac massage, defibrillation, electrocardiography, blood typing, and fluid resuscitation was discovered without any effective integration into the care of countless men and women who could have benefited from this knowledge.
Resuscitation medicine has been plagued with many false starts; discoveries have been made and forgotten. However, the history of resuscitation is not completely filled with dead ends. For example, people noticed that a victim becomes pale and cold before death, and attempts to warm the body is one of the earliest known efforts at resuscitation. Methods to keep a person warm included starting a fire close by, placing a “volunteer” in bed with the patient so that the patient could gain body warmth, and even burying the patient in hot sand. The practice of restoring and maintaining body temperature has been, with few exceptions, a consistent part of resuscitation throughout history. However, for every positive example, there are practices that seem to have persisted, despite evidence of uselessness or harm. For centuries, if a person’s blood “looked bad,” bloodletting by the local barber or surgeon would ensue. It was documented that this would cause weakness or even death. By some estimates, President George Washington had an astounding 3.5 L of blood removed the day that he died from what was determined to be a “throat infection.” Despite contemporary papers against the practice of bloodletting, tradition triumphed and likely resulted in the death of America’s first president (Fig. 1). Nor did bloodletting die there; it continued to be extolled in medical textbooks up until the 1920s!
Resuscitation medicine has been a mosaic of information, conjecture, and disjointed efforts throughout centuries of practice, which perhaps has frustrated efforts to be recognized as a specialized practice of medicine as so many other fields have. We will describe how the theories of resuscitation were started, how they have changed, and how they have been integrated into modern practice. With this in mind, the structure of the review will be around the airway (one of the earliest forms of resuscitation efforts), circulation, and medications. We will discuss the time frame from early civilization until the mid 1950s, corresponding to the approximate era when resuscitation became more organized and systematized in its application to something that we would recognize today.
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