Trauma Resuscitation - Returning Consciousness To Those Near To Death
The first successful trauma resuscitation took place in the 18th century - some 25 years before the beginning of the 19th century.
The Humane Society in London was behind it, which happened on July 16, 1774.
The Humane Society was founded in the Chapter Coffee House of St. Paul’s Churchyard in London in 1774.
It was originally called “The Institute for Affording Immediate Relief for Persons Apparently Dead from Drowning.”
Based on that initial name, trauma resuscitation in that era seemed to focus on reviving those who drowned.
COPYRIGHT_SPINE: Published on https://spinal-injury.net/trauma-resuscitation/ by Dr. Bill Butcher on 2022-10-25T04:45:08.146Z
What’s New in Trauma Resuscitation—Should ABC Become CAB?
Only three months after the society was founded, a member of the society was called to attend to a 3-year-old child named Catherine Sophie Greenhill.
The child fell from an upper story window onto flagstones in nearby Pudding Lane and was pronounced dead.
The society member, an apothecary named Squires, was on the scene within twenty minutes.
According to history records, he proceeded to give the clinically dead child several shocks through the chest with a portable electrostatic generator.
This treatment caused her to regain pulse and respiration, and she eventually (after a time in coma) recovered fully.
The founders of Humane Society, Dr. William Hawes (1736-1808) and Dr. Thomas Cogan (1736-1818), originally positioned attendants at intervals along the banks of the river Thames and paid them 2 guineas to attempt resuscitation to anyone who had drowned (provided their attempts lasted longer than 2 hours!).
Prior to this, it was generally felt that the best thing you could do to a drowned man was pick his pockets.
Other Resuscitation Attempts
At this time, the function of the lungs was unknown.
Oxygen had not yet been discovered (Priestley 1776) and Galen’s idea that the function of the lungs was to cool the heart was widely accepted.
The standard resuscitation regimen at the time was to dry and warm the body by applying friction to the skin, and to administer tobacco smoke enemas.
There were recent clues as to the lung’s function however.
William Harvey had described the circulation of the blood in 1628, and it had been noted that dark venous blood exposed to the air became bright red.
Additionally, there were reports of successful resuscitation of drowned men (and dogs) with bellows.
Paracelsus (1493-1541), an alchemist and perhaps the greatest physician of his age, was said to have attempted the resuscitation of a corpse using bellows, a trick he perhaps picked up from Arabic medical writings.
And Andreas Vesalius (1514-1564), the father of modern anatomy, reported successfully using bellows to resuscitate asphyxiated dogs.
By the 1740s, several cases of successful mouth-to-mouth resuscitation were reported, the most famous of which was Tossach’s 1744 report of the resuscitation of a clinically dead coal miner who descended into a burned-out mine.
Progress In The 19th And 20th Century
English physician, neurologist, and physiologist Marshall Hall (1790-1857) introduced airway clearance in 1856.
In Asphyxia, Its Rationale and Its Remedy (1856), Hall put forward that the restoration of warmth without preventing the victim’s tongue from blocking his airway or providing immediate ventilation was detrimental.
Hall correctly added airway and breathing to the initial steps in resuscitation.
In 1918, original data supporting the “Golden Hour” concept were found in French World War I data:
In World War I, there was a real appreciation of the time factor between wounding and adequate shock treatment. If the patient was treated within one hour, the mortality was 10 percent. This increased markedly with time, so that after eight hours, the mortality rate was 75 percent.
- French World War I data
Below is a table that shows mortality percentage:
|Time from Injury||Mortality|
|1 hour||10 percent|
|2 hours||11 percent|
|3 hours||12 percent|
|4 hours||33 percent|
|5 hours||36 percent|
|6 hours||41 percent|
|8 hours||75 percent|
|10 hours||75 percent|
This data was subsequently used by American surgeon R. Adams Cowley (1917-1991) in his “Golden Hour” concept.
In 1918, the book The Preventive Treatment of Wound Shock by American physiologist W.B. Cannon (1871-1945), John Fraser, and E.M. Cowell was released.
The book shows poor outcome with intravenous fluid resuscitation. It remains largely forgotten until renewed interest in late 1980’s and early 1990’s.
In 1994, William H. Bickell reintroduced the world to permissive hypotension.
Prospective, randomized pre-hospital trial had 598 patients with penetrating torso trauma and systolic BP < 90. The study comparing Standard resuscitation vs. Limited resuscitation (until surgical intervention).
Limited resuscitation gave 375 ml. of IV fluids - 30% mortality and 23 percent complication rate.
Standard Resuscitation averaged 2,480 ml. IV fluid - 38 percent mortality (p=0.04) and 30 percent complication rate - higher than “limited fluid” group.