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Intensive Foresight
The nation's first ICU emerged at Johns Hopkins Bayview 50 years ago.

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Having this team together "works much better than the individual components," says Jonathan Sevransky, right, pictured here with Carol Miller, R.N., and Romergryko Geocadin.

A half-century ago, the offer of $150 to participate in a potentially harrowing medical experiment at the old Baltimore City Hospitals, now Johns Hopkins Bayview, was something third-year medical student Chester Schmidt Jr. felt was too good to turn down—even if it meant being injected with a drug that briefly paralyzed his diaphragm. “That was a lot of money then,” he recalls with a chuckle.

Schmidt, later the long-time director of psychiatry at Bayview, volunteered to let Peter Safar (1924-2003), then head of anesthesiology at City Hospitals, use him as a guinea pig to test his new, groundbreaking methods for cardiopulmonary resuscitation. Such experiments, which subsequently earned Safar recognition as the “father of CPR,” were among the astonishing innovations in critical care medicine that he initiated at City Hospitals—including the opening in September 1958 of the country’s first multidisciplinary intensive care unit (ICU).

Since July, each of Bayview’s six ICUs—medical, surgical, coronary, neonatal, neuroscience and burn—individually has celebrated the 50th anniversary of their prototype’s creation and their own unique contributions to that heritage. The celebration will culminate on September 26th with a day-long symposium at Bayview, featuring lectures by some of the premiere physicians in critical care medicine from around the country.

The event will include the first Peter Safar Lecture, which organizers hope will become an annual event, as well as the official donation of the research papers Safar wrote while working at City Hospitals and serving simultaneously on the Hopkins faculty from 1954 to 1961.

The idea for the ICU celebration was sparked when Romergryko Geocadin, director of Bayview’s neuroscience CCU, attended a staff conference a few years ago and “found that more than half of the people in the room had no idea that the ICU was invented here.
“I thought we have to do something about this,” says Geocadin, a friend and protégé of Safar.

An associate professor of neurology, neurosurgery, anesthesiology and critical care medicine, Geocadin enlisted the help of many Bayview colleagues, including Jonathan Sevransky, head of the medical ICU; Janet McIntire, senior director of patient safety and quality management, and Maria Koszalka, vice president of patient care services, to organize the celebration.

Philip Zieve, former head of Bayview’s department of medicine and chief of the center’s medical staff, was an intern at City Hospitals when the ICU was founded. He recalls Safar as an “aggressive and charismatic” leader of anesthesiology “who believed that there was an opportunity for better respiratory care if the patients could be hospitalized in a single unit with nurses trained to care for people with severely acute problems.”

At the time, City Hospitals was Baltimore’s major polio center, but once the Salk vaccine virtually ended the threat of polio, Safar saw the opportunity to transform the hospital’s four-bed ventilator unit into an ICU, Zieve says. It had round-the-clock staffing by an anesthesiologist, nurses and a surgeon, says Geocadin, and became “the template for what the ICU today looks like.”

The first ICU had just six beds, Zieve recalls. At today’s 709-bed Bayview, one of every six beds is in an ICU, says Sevransky. Last fiscal year, 5,941 ICU patients were treated there, McIntire adds.

In the Hopkins Hospital’s nine ICUs—neonatal, pediatric, cardiac surgical, surgical, medical, neuro critical care, coronary care, oncology and Weinberg—nearly 10,000 patients are treated annually, says Todd Dorman, vice chair for critical care. About 20 percent of the hospital’s 1,017 beds are in ICUs, he adds.

Today, hundreds of nurses and dozens of physicians, respiratory therapists, pharmacists and support personnel work in the two hospitals' ICUs.

With people surviving longer with serious illnesses, “it’s likely that hospitals will become more and more devoted to patients who need life support,” Sevransky says. It is estimated that one percent of the country’s gross domestic product already is being spent on ICU care, he notes.

Among the subjects to be addressed at the symposium will be the future of critical care medicine. In the years ahead, genetics research promises to provide “a lot of cellular approaches to intensive care,” says Geocadin.

Such developments probably would not have occurred to Peter Safar in 1958, but as a tireless innovator, he surely would approve of them now. In addition to his work on CPR, founding the first ICU, and formulating the basic principles of emergency medicine while at City Hospitals, he also contributed to the design of modern ambulances while here. In a 2002 interview with the Pittsburgh Post-Gazette, Safar said that his six years at City Hospitals were the most exciting and happiest of his professional life.

“At the end of the day, after all the hoopla,” says Geocadin, “if we can rekindle the zest of Peter Safar when he was at Bayview creating all of this, it will inspire people.”


—Neil A. Grauer

 

 

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