Friday, June 28, 2013

Peter Safar: Innovator Of Cardiac Resuscitation

Modern Advances In Science

Peter Joseph Safar [1924-2003]: “During his student years he saw the ravages of disease and starvation and the trauma of the battle of Vienna in 1945. These were to have a lasting effect on his psyche and he resolved to try to make the world a better place. He achieved this like no other,” says an article in Elsivier.
Photo Credit: Pittsburgh Post-Gazette, 2003

Peter Safar is credited with coming up with the ABC method of cardiac or cardiopulmonary resuscitation (CPR) ,which is widely used in the world today to prevent individuals from having any lasting effects from heart failure. Such wasn't always the case before the late 1950s, not that long ago. Safar’s experiences during the Second World War had a profound influence on his world-view; he considered himself a pacifist, a humanist and a citizen of the world—a wonderful combination for a medical humanitarian.

The idea of CPR first came to his attention when Safar was working at Baltimore City Hospital around 1958, when he began his research career. There he became interested in unconscious patients, and he was able to show that head tilt, chin lift, and if necessary jaw thrust, would allow a patent to breathe in almost all cases.But there was another piece of the medical puzzle that was necessary for Safar to develop what is now the accepted practice of ABC—airway, breathing and chest compression— in modern cardiac resuscitation.

P.J.F. Baskett  writes in an an article for Elsivier:
Across town at Johns Hopkins, William Kouwenhoven during his study of defibrillation had, almost by chance, discovered that external chest compressions could produce a passable artificial circulation in cardiac arrest in animals. Together with Guy Knickerbocker and James Jude, they were able to demonstrate that this could be reproduced in humans. Safar put the two discoveries together to form the ABC of resuscitation, or CPR as it came to be known, which has stood us in good stead for 45 years. The concept and technique was readily accepted and introduced around the world and was married up to defibrillation which had been recently re-introduced by Beck, Kouwenhoven and Zoll and was to be further developed by Lown and Pantridge.
Moving to the University of Pittsburgh to take up the Chair of the Department of Anaesthesiology in 1961, he built upon his experience in Baltimore and developed an intensive care unit with multidisciplinary participation and training, probably the first of its kind in the US. Realising that professional pre-hospital care was vita to bridge the gap between bystander CPR and hospital intensive care he set about creating one of the early paramedic services in the US. But he did not do it the easy way.
Ever concerned about the underprivileged, and against phenomenal resistance, he selected unemployed black people from an inner city ghetto and, together with Nancy Caroline, trained them to be paramedics. The pilot project, sponsored by the Falk Foundation, was called the Freedom House Ambulance Service. As with most things he did, his tenacity and example prevailed against the odds and that some aspects of this service continues today under the control of the Pittsburgh City authorities.
Such shows that both perseverance and collaboration are necessary to achieve good and positive results; the lone wolf rarely gets anything done. But working assiduously and carefully toward an honourable goal can often get the desired results when the cause is good and others can see it this way.

The Early War Years in Vienna

Peter Safar was born to Karl and Vinca Safar in Vienna, Austria, on April 12, 1924; both his parents were in the medical profession. His father was an noted ophthalmologist and his mother, Vinca, an accomplished paediatrician. Such a family pedigree, and his experiences growing up under a difficult political situation in 1930s Austria, ensured that young Peter would turn his eye to medicine and to helping humanity. In 1938, when Nazi Germany occupied Austria, both of Peter’s parents were removed from their jobs because his mother was considered “Non Aryan.”

Again we turn to P.J.F. Baskett’s article for Elsivier on the following background information, about Safar’s early war years:
Peter was sent into a labour camp in Bavaria, where he was abused mentally and physically and was destined to be drafted into the German Army. ‘‘Our generation was trapped. Active resistance was suicidal... but I was determined not to go to the front to kill and be killed’’. He was saved by his initiative and his eczema which he aggravated by rubbing tuberculin cream in to the sores just before each occasion he was to have a medical examination. Eventually the authorities gave up and he achieved his ambition of starting at the medical school in Vienna in 1943. 
During his student years he saw the ravages of disease and starvation and the trauma of the battle of Vienna in 1945. These were to have a lasting effect on his psyche and he resolved to try to make the world a better place. He achieved this like no other.
There was one bright spot. In 1947 he met Eva [Kyzivat]. They shared similar values and a love of music and dancing —they fell in love —and married in 1950 and spent a lifetime of happiness together. Peter won a surgical scholarship to study Yale in 1949, a year after he qualified as a doctor, and went to the US, the land of opportunity and hope at the time compared with a Europe still in economic and political turmoil. A year later he returned briefly to Vienna, married Eva, and together they went to Pennsylvania with $5 and four suitcases. There Peter embarked on a career in anaesthesiology, having been convinced that that was the speciality for him. At the time this was arguably the best centre in the world led by Robert Dripps, Leroy Vandam, James Eckenhoff and Julius Comroe.
A Citizen of the World

In an article in the National Institutes of Health (NIH) journal (September 12, 2003), Jeanne Leanzer writes further of the inner mind of Safar and how he was successfully able to turn tragedy into victory, becoming the man he became:
Safar’s experiences during the Nazi years had a profound effect on his world view. He worked tirelessly for nuclear disarmament, international law, and world peace through organisations such as International Physicians for the Prevention of Nuclear War and the World Federalist Association (WFA). “He always called himself a world citizen,” said Phil Safar, a lawyer, and the elder of Safar’s two sons.
“He saw a connection between medicine and politics,” said Amy A Langham, executive director of WFA's Pittsburgh chapter, where Safar was active. “He knew that injuries to humans caused by war could be prevented through political cooperation. He saw the United Nations as the only organisation that could bring hope to the idea of world cooperation.”
Another tragedy would have a profound effect on Safar. In 1966, while Safar was away at a medical conference, his 11 year old daughter Elizabeth fell into an asthma induced coma and died. Safar became convinced that lay people, not just doctors, had to be involved in resuscitation if lives were to be saved. One year after his daughter’s death he designed and implemented the first ambulance service with a physician and volunteers trained in CPR.
This was another step in improving the odds of survival for individuals who were undergoing cardiac arrest or a heart attack. Countless lives have been saved by this intervention; and today millions of non-professionals have been trained in CPR methods—myself included—as a way to help humanity. We can thank Dr. Peter Safar for his insight and his understanding of the need to better humanity for making the world a more hopeful and healthier place to reside.

Peter Josef Safar, professor of resuscitation medicine at the University of Pittsburgh, died from cancer on August 3, 2003; he was 79. He was survived by his wife, Eva, and two sons.

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