Heart: An American Medical Odyssey by Dick Cheney, Jonathan Reiner Read Free Book Online Page B

condition called anoxia. While some organs can tolerate anoxia for an extended period of time, the brain cannot, and after just a few minutes, irreversible brain damage occurs.
    In 1933, William Kouwenhoven, an electrical engineer, and colleagues at Johns Hopkins University reported experiments, funded by the Edison Electric Institute, in which for the first time they were able to reverse ventricular fibrillation and restore a normal rhythm by applying a “countershock” of electricity to the thorax of a fibrillating dog.The first successful defibrillation of a human patient occurred in 1947, but only after the chest of the fourteen-year-old boy was opened and electrical current was applied directly to the surface of the quivering heart. The boy made a full recovery.
    In the years that followed, more patients were resuscitated from in-hospital cardiac arrest in this manner but only after enduring an emergency thoracotomy in which an incision was made along the left side of the chest, the ribs spread to expose the heart, and defibrillator paddlesplaced directly against the muscle. Although a step forward, this technique was hampered by two major drawbacks. First, it required an around-the-clock in-house team of skilled surgeons to “crack” the patient’s chest, and second, and just as important, it was time-consuming, a major disadvantage when the time window for resuscitation is a very few minutes. There was thus a need for technology that could promptly detect life-threatening arrhythmias, enable defibrillation of the heart without having to open the chest, and, perhaps of paramount importance, keep the patient alive until defibrillation could be accomplished. Within several years, all three pieces would come together.
    In 1956, one year after President Eisenhower’s heart attack, Dr. Paul Zoll, a Harvard cardiologist, successfully resuscitated a sixty-seven-year-old man using a new external defibrillator, for the first time obviating the need to open a patient’s chest.
    One year later, Zoll developed a method to display a patient’s cardiac electrical activity on an oscilloscope equipped with an alarm capable of detecting a cardiac arrest. This revolutionary technology permitted real-time surveillance of cardiac patients for life-threatening arrhythmias.
    The final piece of the resuscitation puzzle came in 1960 when researchers at Johns Hopkins University described a method of “closed-chest massage” capable of pumping blood in and out of the heart without opening the chest. William Kouwenhoven (who twenty-seven years earlier pioneered defibrillation), James Jude, and Guy Knickerbocker, in a landmark paper published in 1960 in the Journal of the American Medical Association, reported their simple method to squeeze the heart between the sternum and spine by compressing forcefully with the heel of a hand. Kouwenhoven and colleagues wrote:
    Cardiac resuscitation after cardiac arrest or ventricular fibrillation has been limited by the need for open thoracotomy and direct cardiac massage. As a result of exhaustive animal experimentation a method of external transthoracic cardiac massage has been developed. . . . Anyone,anywhere can now initiate cardiac resuscitative procedures. All that is needed are two hands.
    The stage was set for a new way to monitor and resuscitate cardiac patients, and at the meeting of the British Thoracic Society at Harrogate in North Yorkshire, England, on July 15, 1961, Dr. Desmond Julian presented a paper in which he described the rationale for the first coronary care unit:
    Many cases of cardiac arrest associated with acute myocardial ischaemia could be treated successfully if all medical, nursing, and auxiliary staff were trained in closed-chest cardiac massage and if the cardiac rhythm of patients with acute myocardial infarction were monitored by an electrocardiogram linked to an alarm system.
    Years later, Julian noted that it was essentially the success of closed chest cardiac