Episode 11- ELECTRIFYING PROGRESS
Congenital heart defects have led surgeons to develop cardiac surgery. These corrections gave rise to 3 types of complications:
• ventricular fibrillation,
• the electric conduction blockage,
• the identification of a preoperative misdiagnosis.
The most terrifying complication is ventricular fibrillation. It is a fatal arrhythmia.
The ventricles act like Jell-o, but do not contract any longer. Blood circulation is now impossible.
This electric chaos leads to death within a few seconds.
Dr. Claude Beck
In 1947, Dr. Claude Beck, a thoracic surgeon in Cleveland, attempted to correct a major chest deformity in a 14-year-old boy.
This deformity called "pectus excavatum" pushes the rib cage inward and compresses the heart on the spine in a very severe form.
While Dr. Beck finished the surgery as he had many times, the young man’s pulse disappeared! The monitor showed the feared and deadly arrhythmia: ventricular fibrillation.
In all the world's operating rooms in 1947, ventricular fibrillation meant the end of surgery. Ventricular fibrillation can also be spelled d-e-a-t-h!
At the time, it was impossible to bring patients back to life in these situations.
But, things changed that day. Dr. Beck put his knowledge and intuition at the service of his patient.
The surgeon took the heart in his hands and began a cardiac massage at a rate of 60 compressions per minute.
Just before the 1900s, a group of researchers in Geneva had demonstrated that an electric shock to the heart could restore a normal heart rhythm. They had succeeded this in dogs suffering from ventricular fibrillation.
In addition, in the years around World War II, Dr. Carl Wiggen, in Cleveland, was the leader in animal research for ventricular fibrillation. He developed a device that can give an electric shock to the heart through 2 pads applied directly to the heart.
Dr. Beck knew the work of Dr. Wiggen and the existence of his device. As he continued the cardiac massage on his young patient, he asked that we go looking for this device.
It finally arrived in the operating room after 45 long minutes.
The pads are placed directly on the heart without worrying about disinfecting them. The heart resumes its normal electrical rhythm after the application of some shocks and the injection of medications directly into the heart.
The impossible is accomplished. Dr. Beck has just conquered death.
Dr. William Bennet Kouwenhoven
This technique remains very complex since it requires the thorax to be cut open. Can we do otherwise? Dr. Bennet Kouwenhoven, an American, was interested in this question.
Electrical engineer and medical graduate, Dr. Kouwenhoven carried his research on the electricity of the human body. Between 1938 and 1954, he developed the first cardiac defibrillator that can be applied to the skin of the chest, thus avoiding the thorax to be cut open.
He is the initiator of a new concept. He noticed in the dog that an electric shock to the heart causes a noticeable pulsation on the artery of his paw. From this observation was born the thoracic massaage. He launched the modern concept of cardiac reanimation by popularizing the thoracic massage (CPR).
In 1957 Dr. Friesenger, Dr. Kouwenhoven’s assistant, was the first to use the prototype of the external defibrillator with a patient who collapsed during a routine examination.
Dr. Kouwenhoven's recommendations were fully respected. A young doctor in training was assigned to chest massage while others were preparing to deliver the electric shock on the patient's chest. At the second shock, the patient regained consciousness.
The first conventional resuscitation had just occurred.
This demonstrated and confirmed that sternal massaging combined with artificial respiration could maintain life until effective defibrillation takes over in 14 out of 20 patients. Cardiac reanimation performed outside the operating room was now possible.
Dr. Michel Mirowski
From electric shocks giving directly on the heart through a cut-open chest to doing them on the skin, a giant step was taken in cardiac reanimation.
But it was not enough! Some patients are known as being at risk of life-threatening arrhythmia. Cardiac arrest does not forgive. The fatal arrhythmia must be stopped quickly to prevent brain damage.
Dr. Michel Mirowski was interested in the development and the installation in his patients of a device able to detect the arrhythmia and possibly to put an end to it or, if not, to apply an electric shock on the heart, with a closed thorax.
The first prototype was worked on in 1970. It was not until 10 years of improvement that we witnessed the first implantation of this internal defibrillator in a 57-year-old patient at risk of fatal arrhythmia.
Paul Zoll still involved
In parallel, Dr. Paul Zoll, who was collaborating on the development of the cardio stimulator, was now working on the development of external defibrillators, or handheld devices.
In 1980, he founded Zoll Medical, which is now the world leader in external defibrillators and even automated external defibrillators. They have become easier to use and they are accessible to a more and more people worldwide in order to save as many lives as possible.