A Chilly Reception
Date: February 1, 2012
I thoroughly enjoyed “A Dying Dog, A Slow Elevator, and 50 Years of CPR” in the Winter 2011 Hopkins Medicine. (I had meant to get this letter off much sooner; however, even in the later years of retirement, I seem to be short of time to do all that I want.) The description of the pioneering work of Dr. Kouwenhoven, Guy Knickerbocker, and my good friend Jim Jude was clear and interesting. Jim and I were fellow interns at Hopkins in 1953-1954; we have remained close ever since.
The last part of the article deals with the troublesome problem of severe neurological damage in resuscitated patients. This damage is often lethal. A very small percentage of those suffering out-of-hospital arrest survive to leave the hospital alive. Among patients who arrest in the hospital, “the majority of CPR survivors exhibit significant loss of neuronal function,” as Romer Geocadin notes in the article. This observation is followed by a nice summary of some of Dr. Geocadin’s important work with therapeutic hypothermia.
It is worth noting that some of the earliest work on the effect of hypothermia on post-arrest neurologic damage was also done at Johns Hopkins. While I was a surgical assistant resident at Hopkins in the late 1950s, Dr. Frank Spencer, then on the full-time faculty, suggested that early post-resuscitation cooling might be worthwhile. We took the problem to the “dog lab,” where we demonstrated there was indeed some protective effect from post-arrest hypothermia. [Zimmerman, J. M., and Spencer, F. C.: “The Influence of Hypothermia on Cerebral Injury from Circulatory Occlusion.” Surg. Forum IX: 216-218, 1958.]
An interesting thing happened when I presented this work at the American College of Surgeons Clinical Congress in October 1958. There was some media interest in the paper. While I was being interviewed by the science writers, one of them interrupted to say, “Dr. Zimmerman, when you leave this room and go out on the street, you will see that there is a newspaper, Extra, with headlines saying that the Pope has had a stroke. Should the Pope be cooled?” Dr. Alfred Blalock, who had substantial experience with the national press, had prepared me well to provide a noncommittal answer to that sort of question.
Actually, after leaving Hopkins for the faculty at the University of Kansas, I continued to study the effect of post-arrest hypothermia, generally with positive results. This led to several additional publications. However, at that time the concept did not gain any traction in clinical practice.
There is little doubt that hypothermia is helpful in diminishing the neurologic damage after cardiac arrest. It seems to me that the principal challenge is in finding effective and practical means of delivering it to patients.
J. M. Zimmerman, MD ’53
Chief Resident in Surgery, 1958-1959
Chief of Surgery,
Church Home and Hospital, 1965-1997