University Times

Medical pioneer Peter J. Safar, Distinguished Professor of Resuscitation Medicine at Pitt’s medical school, died Aug. 3, 2003, from complications of cancer. He was 79.

Known as the father of cardiopulmonary resuscitation (CPR) — a title he modestly, but unsuccessfully, tried to discourage — Safar helped to create the first U.S. intensive care unit and the first paramedic emergency service. His latest research had involved suspended animation for delayed resuscitation — lowering body temperatures to buy time for patients to be treated and then resuscitated when surgery is complete.

For his internationally recognized work in emergency medicine, critical care medicine, resuscitation research and disaster re-animatology, Safar was nominated three times for the Nobel Prize, most recently in 1994.

“Throughout his distinguished career, Peter Safar worked tirelessly and effectively to cheat death,” said Chancellor Mark Nordenberg. “He fundamentally re-shaped approaches to medical treatment and helped save hundreds of thousands of lives. His own life was characterized by intellectual power, uncompromising standards and personal grace. He was one of a kind and will be sorely missed by his friends and colleagues, here and around the world.”

Patrick Kochanek, director of Pitt’s Safar Center for Resuscitation Research, called his colleague “an incredible man who not only saved a countless number of lives through his work but influenced generations through his genius, elegance, humanism and remarkable purpose. I don’t think a day went by that Peter didn’t do something good for mankind.”

“His innovative work in cardiopulmonary-cerebral resuscitation alone would assure Safar an honored place in the annals of medicine,” the Journal of the American Medical Association (JAMA) stated in a profile published earlier this year. “But his life-giving talents are not limited to medical practice and medical research. In his long career, his humanity and respect for people have enriched students, colleagues and friends; he is a man whose caring soul is perhaps best reflected in his love of music.”

A self-confessed workaholic known to put in 80-hour work weeks, Safar nonetheless made time for playing piano in chamber music ensembles (his favorite composers included fellow Austrians Gustav Mahler and Anton Bruckner) and for ballroom dancing (he and his wife, Eva, won Pittsburgh Symphony Orchestra waltz contests). Safar’s other passions included skiing, mountain climbing and political activism to promote world peace; he was a member of Physicians for Social Responsibility, the International Physicians for the Prevention of Nuclear War and the local chapter of the World Federalist Association.

Born in 1924 in Vienna to parents who were physicians, Safar later would tell JAMA: “I grew up among a big circle of physicians. My decision to go to medical school was self-evident. My parents were great role models.”

But entering medical school became problematic for Safar after Nazi Germany annexed Austria in 1938. Because Safar’s maternal great-grandfather had been Jewish, he was racially suspect under Nazi doctrine. Drafted into the German army during World War II, Safar relied on guile (using an incipient skin condition as an excuse for long-term hospital treatment), friends and sympathetic officers to avoid being sent to Stalingrad as cannon fodder. He entered the University of Vienna Medical School in 1943 and graduated in 1948. The following year, Safar came to the United States for a surgical fellowship at Connecticut’s Yale New Haven Hospital. There, he came to a career-defining realization: Surgery would not advance without better life support techniques, and anesthesiology was the field in which you learned about life support. Safar went to the University of Pennsylvania in 1950 to serve his anesthesiology residency.

In 1952, he and his wife Eva, whom he had married two years earlier, moved to Lima, Peru, where Safar created that country’s first academic anesthesiology department. He returned to the United States two years later to work at Baltimore’s Johns Hopkins Hospital and Baltimore City Hospital. He founded the latter hospital’s academic anesthesiology department and, in 1958, he established the country’s first medical-surgical physician-staffed intensive care unit there.

Also in Baltimore, Safar did his pioneering research on CPR. Through experiments that involved temporarily stopping the breathing of volunteers (experiments that would be forbidden under current rules protecting research participants’ safety, Safar later would point out), he and other scientists perfected the technique of tilting back a person’s head to clear the air passage for mouth-to-mouth resuscitation. Combining this with existing cardiac compression techniques to maintain blood flow to the brain, Safar and his team created modern CPR.

In 1961 Safar came to Pitt. Here, he founded the Department of Anesthesiology and Critical Care Medicine, which today is the country’s largest academic anesthesiology department. In 1979, at age 55, Safar stepped down as department chairperson. He continued as a practicing anesthesiologist until age 65.

Safar founded Pitt’s International Resuscitation Research Center (IRRC) in 1979. He directed the center until 1994, when at age 70 he turned the IRRC leadership over to Patrick Kochanek, who renamed it the Safar Center for Resuscitation Research. Safar continued to lead research programs on cardiac arrest, traumatology and suspended animation, continuing to work despite exhausting surgeries and chemotherapy to treat a malignant pelvic tumor discovered in May 2002.

Safar’s later research was aimed at saving the brain as well as the heart and lungs from damage, through what he called cardiopulmonary-cerebral resuscitation (CPCR). This shift in research focus was motivated by the 1966 death of Safar’s 11-year-old daughter, Elizabeth, who went into a coma after a severe asthma attack. Safar was able to revive his daughter’s heart and lungs, but she suffered fatal brain damage. One of Safar’s last major public appearances was as the featured speaker at Pitt’s honors convocation on Feb. 28. Looking frail and addressing the audience from his chair on the podium, Safar lauded Western humanist values and academic freedom.

“Teachers should have freedom in what to teach, whom and how, what to investigate and what to publish,” he said. “This freedom is so important because often directions, documentations and discoveries may not agree with currently accepted ideas and values.”

He cited discoveries in his own field of resuscitation medicine. Mouth-to-mouth resuscitation, first practiced in the 18th century, was abandoned by science only to resurface in the 1950s, and external heart massage, practiced in the late 19th century, was forgotten until 1958, Safar said. Likewise, saving brain cells with hypothermia “was suggested in the 1950s, then dropped because of side effects, and revived in the 1980s through serendipitous novel re-discoveries,” he said. “Many discoveries have been re-discoveries.”

Safar also argued that universities and academic medical centers should lead the way in promoting a single-payer national health care system covering basic needs. And he urged his listeners to work for peace and to “remember and pass on” the academic values they learn at Pitt. “Few creations of homo sapiens have the opportunity to promote the goodness of mankind, including work ethic and integrity, as much as universities and their medical centers,” Safar said.

Safar is survived by his wife of 53 years, Eva; his sons Philip of Wenatchee, Wash., and Paul of Eugene, Ore., and five grandchildren. A Heinz Chapel memorial service is tentatively set for Oct. 29, at a time to be announced.

— Bruce Steele