HEART SURGERY: RESUSCITATION

A Cure That Kills

Imagine the following scene. In early-twentieth-century America, a middle-aged man leaving the theater clutches his chest, then he drops to the ground. The cry goes out, "Is there a doctor in the house?" Up walks a physician. He proceeds to cut open the man's chest and squeeze the heart into activity again. All cheer as the victim, momentarily revived, is rushed to the hospital. He dies a few days later. Scenes such as this were played out repeatedly as Good Samaritan physicians applied what was then state-of-the-art medicine. A few patients' lives were saved by this routine; it was better than no treatment at all, but the cure was nearly as deadly as the illness.

Hand-Pump Resuscitation

In 1960 Dr. W. B. Kouwenhoven, a Ph.D. in electrical engineering at Johns Hopkins University, started advertising a new technique for cardiac resuscitation. Calling it the hand-pump, or closed-chest, massage, he developed the technique in collaboration with a group of Johns Hopkins physicians. Kouwenhoven claimed that even nonphysicians could learn the method, and early results showed that it was very effective.

The Technique

The hand-pump method does not require cutting open the chest at all. Instead the hands are used to apply and release pressure rhythmically over the lower part of the breastbone. The pressure pushes the chest cavity down about an inch, squeezing blood out of the heart. Releasing the pressure allows blood to flow into the heart for the next cycle. This technique, now performed with mouth-to-mouth resuscitation, is known as cardiopulmonary resuscitation (CPR) and is used to revive victims of heart failure.

Encouraging Results

Before teaching the method widely, Kouwenhoven worked with Dr. Alfred Blalock to test it. They chose people who had died on the operating table. Of the twenty patients tested, 70 percent were revived. Using open-chest heart massage, only 40 percent were expected to have been resuscitated. Kouwenhoven and Blalock taught the hand-pump system to Baltimore firemen who manned the city's ambulance service. Within the first three months they revived six patients in public without opening any chests. Today the hand-pump system is the standard against which alternative methods are judged.

Sources:

Paul W. Kearney, "If a Heart Stops Beating—There's Help at Hand,"

Reader's Digest, 77 (November 1960): 96-99;

"Without the Knife…," Newsweek, 56 (18 July 1960): 56.