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William Kouwenhoven (January 13, 1886 - November 10, 1975) Born in the United States Year of Discovery: 1957
Utility Linemen Electrocution Study Led to CPR!
In the 1920s electricity was poised to revolutionize life as we knew it, adding many of the latest conveniences to our homes. At the time, very little was understood about the dangers associated with electrocution. As companies scrambled to install electricity in the houses of their new customers, they noticed that many of their utility linemen were suffering sudden death, even from the smallest voltages. Scientists began to study the mechanism of these heart stopping shocks, but William Kouwenhoven and his laboratory at Johns Hopkins University went a step further and discovered that electricity could also re-start the beating of a heart. This work was the foundation of the life saving cardiac defibrillator and progressed to the development of the technique of external cardiac massage (chest compressions) during CPR (Cardiopulmonary Resuscitation).
Kouwenhoven was born in Brooklyn, New York on January 13, 1886 and joined the faculty of the Johns Hopkins University School of Engineering in 1914 as a professor of electrical engineering. He always had great interest on the effects of electricity on the body, so when Edison Electric decided to fund research into the sudden deaths by electrocution of their linemen, it was Kouwenhoven’s opportunity to shine. Even though he had no formal medical training, his laboratory became focused specifically on the effects of electricity on the heart, from both the inside and outside of the body.
The first investigations were done on rats in 1928. They found that high voltage shocks from electrodes placed on the head and one extremity would stop breathing and the heart from pumping. They also tried to massage the chests of the rats, as recommended by a German physician, Dr. Boehn, but this only resulted in paralysis of the rats from crushed cervical spines. By 1933, their work on dogs showed that an alternating electrical current applied directly to the heart could restore the heartbeat but this method required opening the dog’s chest, which was difficult and less than desirable. In the late 1940s this method of open chest heart re-starting (defibrillation) became used on human patients quite regularly because it was the only option available to save patients’ lives.
Kouwenhoven was convinced that he could develop a solution and a device (a defibrillator) that could shock the heart without opening up the patient. A lot of medical research was put on hold during World War II, but by 1957, Kouwenhoven and his team had finally perfected the defibrillator device. It consisted of a small box and two insulated cables with copper electrodes. Johns Hopkins Hospital immediately began using the device as a standard treatment for cardiac arrest.
Guy Knickerbocker, working toward his PhD in electrical engineering, started in Kouwenhoven’s laboratory on defibrillator experiments in 1954. He realized that by placing the heavy copper electrodes on the chests of animals , it caused their blood pressure to rise and when he pressed down with the electrodes, it rose even higher. This observation was critical in determining that once a heart had stopped, forceful, rhythmic chest compressions could cause blood to move through the body, keeping vital organs alive!
Kouwenhoven and Knickerbocker worked with cardiac surgeon, James Jude to test this life sustaining theory. They checked and double checked their findings on many patients for over a year before announcing the results of their discovery: Chest compressions could maintain 40% of a patient’s normal circulation when their heart had stopped beating. This was combined with mouth to mouth resuscitation to become universally known as Cardiopulmonary resuscitation, or CPR.
Kouwenhoven held the position of Dean at Johns Hopkins School of Engineering from 1938 until 1954. In 1969, he received the very first honorary degree ever given by the Johns Hopkins University School of Medicine.
Explore other scientists who furthered this lifesaving advance.
Lifesavers Who
Developed CPR
Peter Safar The Father of CPR, taught regular people to be lifesavers.
James Jude Proved that chest compressions, using the hands, were sufficient to extend life in emergencies.
G. Guy Knickerbocker Proved that chest compressions, using the hands, were sufficient to extend life in emergencies.
James Elam Spearheaded the development of Resusci-Anne, a life-like manikin to teach CPR.
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Comments (1)
1
Monday, 06 August 2012 07:48
p. eastman
I would never discount William Kouwenhoven's contribution to the development of the defibrillator, but I think it is remiss to not mention that Paul ZOll MD, published the first close chest defibrillation paper at least a year before Dr K was claimed to have been the first to have developed the defibrillator????? The following is a summary of Dr Zoll's achievement's, as summarized by the Heart Rhythm Society:
Paul M. Zoll was born and educated in Boston MA. He attended Harvard Medical School and trained and practiced at the Boston Beth Israel Hospital for the remainder of his career. During the Second World War he and Dwight Harken described the operative removal of foreign bodies, shrapnel, bullets and other metallic objects from within and about the heart and great vessels. These publications were important for the demonstrated ability to operate on the heart with patient survival, an intervention that had previously been done infrequently and as a singular tour de force. In 1950 a presentation at a meeting of the American College of Surgeons, in Boston, about stimulating the sino-atrial node via a transvenous catheter, inspired Zoll to develop a technique for pacing the heart through the intact chest during asystole. With an epochal publication in 1952 he described cardiac resuscitation via electrodes on the bare chest with 2 ms duration pulses of 100-150 volts across the chest, at 60 stimuli per minute. This initial clinical description launched widespread evaluation of pacing and the recognition by the medical profession and the public that the asystolic heart could be stimulated to beat and was the basis for future clinical pacing developments. This technique eventually fell from favor, except as an emergency, because of associated pain and the limited mobility it allowed the patient. It was later revised using larger skin electrodes and longer pulse durations, both of which made the shocks less painful and therefore more acceptable. In 1955 Zoll described a mechanical technique for "stimulating" the asystolic heart. In 1956 he published a transcutaneous approach to terminate ventricular fibrillation with a much larger shock, of up to 750 volts and later described similar termination of ventricular tachycardia. His use of an alternating current shock began clinical cardioversion-defibrillation, but eventually was replaced by direct current shock, largely for technical reason.
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Paul M. Zoll was born and educated in Boston MA. He attended Harvard Medical School and trained and practiced at the Boston Beth Israel Hospital for the remainder of his career. During the Second World War he and Dwight Harken described the operative removal of foreign bodies, shrapnel, bullets and other metallic objects from within and about the heart and great vessels. These publications were important for the demonstrated ability to operate on the heart with patient survival, an intervention that had previously been done infrequently and as a singular tour de force. In 1950 a presentation at a meeting of the American College of Surgeons, in Boston, about stimulating the sino-atrial node via a transvenous catheter, inspired Zoll to develop a technique for pacing the heart through the intact chest during asystole. With an epochal publication in 1952 he described cardiac resuscitation via electrodes on the bare chest with 2 ms duration pulses of 100-150 volts across the chest, at 60 stimuli per minute. This initial clinical description launched widespread evaluation of pacing and the recognition by the medical profession and the public that the asystolic heart could be stimulated to beat and was the basis for future clinical pacing developments. This technique eventually fell from favor, except as an emergency, because of associated pain and the limited mobility it allowed the patient. It was later revised using larger skin electrodes and longer pulse durations, both of which made the shocks less painful and therefore more acceptable. In 1955 Zoll described a mechanical technique for "stimulating" the asystolic heart. In 1956 he published a transcutaneous approach to terminate ventricular fibrillation with a much larger shock, of up to 750 volts and later described similar termination of ventricular tachycardia. His use of an alternating current shock began clinical cardioversion-defibrillation, but eventually was replaced by direct current shock, largely for technical reason.