DR PETER SAFAR was a crucial figure in the development of resuscitation’s ABC: airway, breathing and circulation. For helping to create the technique that combines “mouth-to-mouth” ventilation with chest compression to revive victims of heart attacks, drowning and choking, Safar was known as the father of cardiopulmonary resuscitation (CPR). He also helped to develop the modern ambulance and the concept of intensive care.
Mouth-to-mouth ventilation had been recorded in the 18th century — “many discoveries have been rediscoveries,” Safar said — though for years after that it was ignored. In 1956 Safar returned to the technique when he used volunteers to examine methods of airway control, through tilting the head backwards and opening the mouth, and breathing, as methods of resuscitation. The research, published in 1958, demonstrated that these techniques were better for improving ventilation than the method recommended at the time of pushing on the back to expel air and lifting the arms to inflate the chest.
Safar and his colleages then added the third step, circulation, stimulated by external heart massage. This had been attempted in the 19th century and others had carried out research into the technique. But with the first two steps, it formed the new lifesaving method of CPR.
Peter Safar was born in Vienna; his mother was a paediatrician, and he became attracted to medicine when his father, an ophthalmic surgeon, let him look through a microscope. He was conscripted into the German Army in 1942 but having briefly worked as a paramedic, he attended the University of Vienna School of Medicine from 1943 until 1948.
Safar had a surgical fellowship at Yale in 1949-50 and for the following two years studied anaesthesiology at the University of Pennsylvania. He soon realised that the methods used to keep patients alive during surgery could be applied to other cases, where patients were near death.
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In 1952 he worked at the National Cancer Institute in Lima, where he established an anaesthesiology department, and in 1954 he joined the staff of Baltimore City Hospital, now Johns Hopkins Bayview Medical Centre. The following year he founded the hospital’s anaesthesiology department.
It was there that Safar’s research into cardiopulmonary resuscitation began, and it was there in 1958 that he established America’s first multidisciplinary intensive care unit, staffed around the clock. In these productive years he also helped to develop prototypes of the modern ambulance, having realised that people were not receiving treatment on the way to hospital.
In 1961 Safar joined the department of anaesthesiology at the University of Pittsburgh. The next year he founded an innovative programme for training in intensive care, and to account for this he changed the name of the department, which became the largest for academic anaesthesiology in America. Meanwhile, further study of life support led to the development of the nine-step technique of cardiopulmonary cerebral resuscitation.
In 1979 Safar became the founding director of the International Resuscitation Research Centre at the University of Pittsburgh. He ran it until 1994, and when he retired, becoming an adviser, it was renamed the Safar Centre for Resuscitation Research.
For years Safar had been interested in cooling patients as a means of revival after cardiac arrest and shock, and in the 1980s his group had reopened research into the uses of mild hypothermia. The idea had been suggested in the 1950s but was then dropped because of its side- effects. Last year studies were published that found that mild cooling did prevent brain damage after cardiac arrest. “A little bit of cool is good,” Safar said. “Cold reduces oxygen demand and, equally important, suppresses chemical reactions which tend to kill cells.”
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Safar wrote almost 400 peer-reviewed publications and more than 30 books, and was preparing another on resuscitation medicine in the past century. He was an active supporter of “peace medicine”, which includes work for non-governmental organisations, such as the World Association for Disaster and Emergency Medicine, which he helped to found in 1976.
He was a founding member of the American Heart Association’s CPR committee and co-founder and president in 1972 of the Society of Critical Care Medicine, and in 1982 he initiated the journal Prehospital and Disaster Medicine. His background led to his receiving the Austrian Cross of Honour and was perhaps responsible for his expertise at waltzing. He was very fond of classical music and enjoyed playing the piano.
He is survived by his wife, Eva, whom he married in 1950, and their two sons. His daughter predeceased him.
Dr Peter Safar, founding director of the International Resuscitation Research Centre, was born on April 12, 1924. He died of cancer on August 3, 2003, aged 79.