Personal reminiscences of the origin and history of cardiopulmonary resuscitation (CPR).

T origin of cardiopulmonary resuscitation (CPR) followed a sequence of events that began in my medical school years. I married a woman from Baltimore between my second and third year in medical school at the University of Minnesota (Minneapolis, Minnesota), which ultimately led to my training at Johns Hopkins (Baltimore, Maryland). Other events in medical school, however, also contributed. During my senior year, I spent some time doing research under F. John Lewis (who performed the first successful human open heart operation: the closure of an ostium secundum atrial septal defect under hypothermia, at the University of Minnesota Hospital in 1952,1 a case that I was fortunate to be allowed to watch). My research, utilizing rats, was on whether it was safer to rewarm them faster or slower from total body hypothermia. This initiated my later interest and research into hypothermia, which led to my meeting G. Guy Knickerbocker and Dr. William Kouwenhoven. Interestingly, in total body cooling, the rat’s heart rhythm would switch at around 20°C to 25°C, either to a profound bradycardia or go into ventricular fibrillation (VF). Defibrillators were not yet commonly in use or available at this time. With the energy that comes with youth, at Hopkins, I worked 24-hour days as an intern, under the stimulus of the professor, Dr.Alfred Blalock (Director of the Department of Surgery), who together with pediatrician, Helen Taussig, and his research laboratory director, Vivian Thomas, developed the blue baby operation (a left subclavian artery to pulmonary artery shunt that created a palliative increase in overall oxygenation by converting a tetralogy of Fallot to a pentalogy).2 I sometimes spent an occasional day and many evenings in the old Hunterian laboratory. There on the second floor of the Hunterian laboratory, was this “old gentleman” who walked with a limp, and who was experimenting with high voltage electricity. The “old gentleman” was William Kouwenhoven, Dean of the Johns Hopkins University School of Electrical Engineering (later to become the Whiting School of Electrical Engineering). Dr. Blalock had given him a place to study the effects of electricity on the heart under a grant from the Edison Electric Institute. This was a continuation of his studies of the effects of electricity on humans, and, especially cardiac function, going back to 1928. The Hunterian laboratory was soon replaced by a newer building for other medical school uses, and surgical research transferred to the twelfth floor of the newly constructed Clinical Science Building (now the Blalock Clinical Science Building). I was fortunate enough at the end of my surgical internship, July 1, 1954, to be selected to stay at Hopkins for the next year as an assistant resident in surgery; at the end of that year, July 1, 1955, I went, as a Cushing Fellow in Cardiac Surgery Research, to the newly located surgical laboratory. Continuing my studies on hypothermia, I was running into the problem of VF in a large number of animals, during induction of hypothermia. Dr. Kouwenhoven was now also situated in the new laboratory, but had retired as Dean of the School of Electrical Engineering; he was continuing his studies on electricity and its effects on humans, as a Lecturer in Surgery, in the emerging field of biomedical engineering. G. Guy Knickerbocker was now also working under him, toward his PhD in electrical engineering. Dr. Kouwenhoven continued his studies with a major grant from the Edison Electrical Institute and some additional support from the National Institutes of Health (NIH; Bethesda, Maryland). He had developed a crude, externally applicable, alternating-current cardiac defibrillator3 using electrical outlet power stepped up to a 440-V alternate currrent (AC). He had a prototype similar to one concomitantly developed in Boston by the cardiologist, Paul Zoll.4 A similar crude device, but using a lower voltage, was also available for direct application to the heart, having been the first means of defibrillation developed by Dr. Kouwenhoven. I needed to reverse the VF, which was ruining up to 1/3 of my studies. Guy Knickerbocker was consulted from down the hall in Dr. Kouwenhoven’s laboratory, and he brought his equipment to my laboratory. If the VF did not exist for more than a minute or two before the external defibrillating electrodes were applied, the defibrillation was generally successful and my own studies could continue. Thus, as researchers, we helped one another with merging goals, and most importantly, set up a communication line to be used later. I was able to make my first scientific presentation5 in Atlantic City at the meeting of the American Physiology Society, in April 1956, on work done while in the laboratory with the assistance of Dr. L.M. Haroutunian, a fellow in Medicine, and Roland Folse, then a senior medical student. Dr. Arthur Otis of the PhysiFrom the University of Miami School of Medicine, Miami, Florida. Manuscript received April 14, 2003; revised manuscript received and accepted June 23, 2003. Address for reprints: James R. Jude, MD, 200 Edgewater Drive, Coral Gables, Florida 33133. E-mail: jjude33333@aol.com.