Cardiac Arrest

How the Times Have Changed: Emergency Cardiac Care

This Editorial is a personal reflection on an article from the Consultant archives.



William J Brady, MD

University of Virginia School of Medicine



Brady WJ. How the times have changed: emergency cardiac care [published online October 26, 2018]. Cardiology Consultant.


Jude JR. How to perform closed-chest cardiac massage. Consultant. 1961;1:4-7.


In the late 1950s, the technique of external cardiac massage was developed at Johns Hopkins University by 2 electrical engineers (William Kouwenhoven, PhD, and Guy Knickerbocker, PhD) and a surgery resident (James Jude, MD), as detailed by Dr Jude in his 1961 report in Consultant.


Kouwnhoven and his team had also developed electrical defibrillation of the heart, initially performed only during chest surgery (the “open-chest” defibrillation) and subsequently accomplished via the “closed-chest” method, the forerunner of today’s external cardiac defibrillation.

closed-chest cardiac massage

These 2 techniques represent the foundation of contemporary emergency cardiac care used in the resuscitation of cardiac arrest. In fact, these interventions represent the medical therapies with the greatest positive impact on both survival and intact neurologic status among survivors of cardiac arrest.


Early on, soon after their development, these interventions were only performed in the hospital by physicians. Today, cardiopulmonary resuscitation (CPR) and electrical defibrillation continue to be performed in the hospital setting throughout the world, but now they can also be performed by anyone in the out-of-hospital setting, before the arrival of EMS and long before arrival at the hospital. CPR and external defibrillation, which is performed using an automatic external defibrillator (AED), can greatly increase the chance of meaningful survival from cardiac arrest in the out-of-hospital environment.  These interventions, performed by lay providers prior to EMS arrival, is termed pre-arrival care.


Approximately 60 years after their development, these techniques have undergone refinement with further improvements in patient outcome. Yet the basics of their interventions remain the same. Not only do hospital-based clinicians use these techniques, but also lay providers with and without formal training can correctly and safely care for individuals having out-of-hospital cardiac arrest with significant positive impact on meaningful survival.


Kouwenhoven, Knickerbocker, and Jude—two electrical engineers and one surgery resident physician—created medical interventions that are still used daily in a range of resuscitation settings and have saved countless lives throughout the world.



William Brady, MD, FACEP, FAAEM, is a professor of Emergency Medicine and is the David A. Harrison Distinguished Educator at the University of Virginia School of Medicine