Peter Safar, who has died aged 79, was an architect of modern emergency first aid. A pioneer of the kiss-of-life technique to revive victims of heart attack, drowning and choking from smoke inhalation and allergic reactions, his work has defined 50 years of progress in the ethical dilemmas, as well as the technical aspects, of resuscitation.
He had an immeasurable influence on the determination of brain death, and eloquently promoted titrated terminal care. The emergency revival techniques he developed for hospital staff and paramedics save thousands of people from premature death every year.
His many innovations for recovery from cardiac arrest and shock included techniques based on the idea that mild hypothermia could prevent brain damage. But his career was reinforced by tragedy. He and his wife were away from home when their only daughter and eldest child, 11-year-old Elizabeth, had a devastating asthma attack and sustained a cardiac arrest before Safar could reach her. Although her circulation was restored, she suffered brain death.
Safar was born in Vienna, the son of an ophthalmologist father who was dismissed from his teaching post for refusing to join the Nazi party, and a paediatrician mother who was sacked because she had a Jewish grandmother.
After high school, he was sent to a labour camp to dig ditches. In 1942, he was briefly conscripted into the German army, then rejected as unfit and sent to work as a paramedic and critical-care nurse in a hospital caring for burn victims from the front. He was accepted into the University of Vienna medical school in 1943 when an official chose to ignore his Jewish heritage, and qualified in 1948.
After holding a surgical fellowship at Yale from 1949 to 1950, Safar moved to the University of Pennsylvania to train in anaesthesiology - it was here that he developed his ideas about how the methods used to sustain patients during surgery could be refined for emergency resuscitation of people close to death.
He then moved to the national cancer institute in Lima, Peru, where he established an anaesthesiology department, before, in 1954, joining the Baltimore City hospital, Maryland (now Johns Hopkins Bayview Medical Centre), where his research in cardio-pulmonary resuscitation began in earnest. In Baltimore, he created the first US multidisciplinary medical-surgical intensive care unit.
Safar also began his lifelong crusade for the training of lay people in first aid and other life-saving techniques, largely because they were often the first on the scene in life-threatening situations. He preached the need for a cadre of specially trained non-physicians to carry out treatment on the way to hospital, an idea he was convinced could save many from dying needlessly before they reached the emergency room. The result of his efforts can be seen in the modern ambulance, and today's methods of intensive care based on Safar's ABC of resuscitation: airway, breathing and circulation.
In 1961, Safer joined the anaesthesiology unit at the University of Pittsburgh, where he established the world's first multidisciplinary critical-care fellowship training programme. Under his direction, its work extended to such areas as respiratory therapy, pain management and disaster reanimatology.
Following his daughter's death in 1966, he intensified his energies in research into brain resuscitation; he was a co-founder of the Society of Critical Care Medicine, and, created the international resuscitation research centre at Pittsburgh.
Safar's studies in brain resuscitation focused on hypo-thermia. The fundamental challenge of resuscitation, he said, lay not in the heart but in the brain: "When sudden cardiac death occurs at normal body temperature, brain damage will be permanent after five minutes." Although the heart can recover after nearly 20 minutes without a beat, brain cells are more delicate.
When blood stops flowing, the cells exhaust their oxygen reserves in a mere 10 seconds, at which point the patient loses consciousness. After the last reserves of glucose disappear five minutes later, cells literally poison themselves with a toxic cascade of chemical reactions.
During the 1980s, Safar discovered that this toxic cascade could be slowed by mild hypothermia - lowering the body temperature by 7.2 degrees Fahrenheit. In experiments on dogs, he found that if he lowered their temperature for 12 hours, while increasing their blood pressure just enough to keep blood moving through stressed blood vessels, the five-minute time limit for surviving cardiac arrest could be extended to 10 minutes.
The procedure was never implemented because, until recently, no one could find a simple way to cool a human fast enough. Unexpectedly, however, a new technique that can fill the lungs with a chilled, breathable liquid may change things. Researchers claim that the liquid treatment can double the survival times without blood flow and enable perhaps one patient in three to survive cardiac arrest.
Safar's interests ranged over many fronts. A relentless campaigner for world peace, he was a member of Physicians for Social Responsibility and International Physicians for the Prevention of Nuclear War. His wife Eva and two sons survive him.
· Peter Safar, physician, born April 12 1924; died August 3 2003.
