Vladimir Negovsky: a dream incarnation
Keywords:resuscitation, cardiopulmonary and cerebral resuscitation, post-resuscitation disease, intensive care, history of medicine
The article deals with the life path and research activities of the founder of resuscitation science (intensive care) Vladimir A. Negovsky. He was born in 1909 in the city of Kozelets, Ukraine. After graduating from university in 1933, Negovsky worked as a researcher in the pathophysiological laboratory of the Central Institute of Hematology and Blood Transfusion in Moscow, where he worked for about a year with Professor S.S. Bryuchonenko, the creator of one of the world’s first heart-lung apparatus and where, apparently, his scientific interests were finally formed. In 1936, Negovsky wrote a letter to the Prime Minister of the USSR V.M. Molotov, in which he substantiated the prospects and importance of research in the field of cardiopulmonary resuscitation and asked for help in creating a research laboratory on this problem. Surprisingly, his request was granted — in the same year an order was issued on the organization of a special-purpose laboratory on the problem: ‘Restoration of life processes in phenomena similar to death”. Such a scientific research laboratory was created for the first time in the world. V.A. Negovsky and his collaborators modified the resuscitation method proposed by F.A. Andreev (1879–1952) and included the injection of Ringer-Locke’s solution with adrenaline into the carotid artery towards the heart (centripetally, i.e. against the blood flow). This method was improved by Negovsky and the Laboratory staff by using the radial and brachial arteries as an access for centripetal blood injection, which made it possible to simplify the technique for use in clinical practice and was supplemented by artificial lung ventilation by forced air injection into the lungs with bellows, as they have shown that intra-arterial pumping alone without mechanical ventilation is often ineffective. In the years before the attack of Nazi Germany on the USSR (1938–1941), V.A. Negovsky and his colleagues carried out a series of experimental studies devoted to the resuscitation of animals with lethal blood loss, as well as to the problem of extinction and restoration of brain functions, the results of which were published in several articles. In 1942, V.A. Negovsky defended his PhD on the topic “The relationship of respiration and blood circulation in the process of dying of animals from blood loss and in the subsequent period of restoration of vital functions”. During World War II, Negovsky organized a front-line medical teams, with which he went to the front line and where, in 1943, the developed complex of resuscitation measures was first used for wounded soldiers. In his dissertation on medicine “Restoration of vital functions of an organism in a state of agony or a period of clinical death” defended in 1943, he outlined the main provisions of the pathophysiology of terminal states and the principles of a complex method of resuscitation; the dissertation was published in a book in the same year. In 1945–1946, V.A. Negovsky publishes reports in the journals “JAMA” and “Nature” about the clinical experience of using the developed method of cardiopulmonary resuscitation and the importance of developing this problem of medicine, thus providing a priority in creating a new scientific direction. In 1946, using the experience gained in the war, the Laboratory staff continued their clinical work, starting to provide medical care to dying patients at the Institute of Thoracic Surgery of the USSR of the Academy of Medical Sciences, thus creating their own clinical resuscitation unit. In 1947, V.A. Negovsky was awarded the title of professor. Despite the successes achieved, Negovsky and his colleagues had to overcome stubborn misunderstanding and expressed resistance from many representatives of the medical community. An interesting fact in the biography of V.A. Negovsky was his participation in 1953 in the CPR (chest compression and administration of pharmacological drugs) of Joseph Stalin. In 1952, the Laboratory team created the first instruction, which was published by the USSR Ministry of Health for use in clinical practice “On the introduction into medical practice of methods for restoring the vital functions of an organism in a state of agony or clinical death”, which was republished in 1955, 1959 and 1963 with the introduction of changes to the CPR algorithm. In 1959, on the initiative of V. \A. Negovsky, the first prototype of the intensive care unit in the USSR was organized, which was named “Center for the Treatment of Shock and Terminal States”. In 1961, he reported about creating a new medical science — resuscitation science, the subject of which is nonspecific general pathological reactions of the body, pathogenesis, therapy, and prevention of terminal states, life support in critical states. In 1972, in the first issue of the newly created journal “Resuscitation”, V.A. Negovsky published an article “The second step in resuscitation — the treatment of the ‘post-resuscitation’ disease”, in which he outlines the pathophysiological mechanisms of the development of post-resuscitation changes in the body. A special topic is overcoming the “iron curtain” and acquaintance of V.A. Negovsky with the American founder of the first Intensive Care Units (ICU) P. Safar, who laid the foundation for many years of scientific interaction and personal friendship. In 1985, on the basis of the Laboratory, Negovsky organized the Research Institute of General Reanimatology of the USSR of the Academy of Medical Sciences, which now bears his name. Vladimir Negovsky loved classical music, especially I.S. Bach, painting — Sandro Botticelli, Francisco Goya, always found time and energy for skiing. He died on August 2, 2003, and is buried in Moscow.
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