How A Rebellious Doctor Changed Cardiology Forever

In the early 20th century, direct assessment of the living human heart remained a significant challenge, with understanding largely limited to external examination and imaging. Against this backdrop, in 1929, a young German physician, Werner Forssmann, conceived of a revolutionary idea: to access the heart directly via the venous system using a catheter. However, the prevailing medical opinion deemed such intravascular access as prohibitively dangerous, and Forssmann was explicitly forbidden by his superiors from attempting this procedure on a patient, reflecting the deep-seated concerns within the medical community at the time regarding any direct intervention involving the heart.

Despite being forbidden, Forssmann was profoundly convinced of his concept's potential. In an act of audacious self-experimentation, he chose to prove the feasibility and relative safety on himself. After administering local anesthetic to his arm, he carefully inserted a catheter into his antecubital vein and, using fluoroscopy for guidance, successfully advanced it into his own right atrium. This unprecedented act provided the first empirical evidence that cardiac catheterization was achievable in humans. Although his defiance and the self-experiment led to initial professional censure, Forssmann's groundbreaking work laid the essential foundation that André Cournand and Dickinson Richards later built upon, ultimately establishing cardiac catheterization as a cornerstone of modern cardiovascular diagnosis and intervention.

Welcome to the 117th edition of ResusNation!

Never Stop Compressions & Place The SGA

As a seasoned medical professional, I've seen firsthand the critical importance of maintaining uninterrupted chest compressions and timely defibrillation during cardiac arrest. The debate between early supraglottic airway placement versus endotracheal intubation, highlighted by Melody RT and Nick Nguyen, is certainly relevant. While both approaches can be valid depending on the circumstances and the team's expertise, the evidence strongly suggests that any pause in chest compressions for intubation, even a brief one, can negatively impact patient outcomes and increase mortality.

My experience aligns with the studies: prioritizing continuous chest compressions and rapid defibrillation is paramount. Therefore, I advocate for the initial placement of a supraglottic airway to secure ventilation and oxygenation quickly without interrupting these life-saving interventions. Once return of spontaneous circulation is achieved, we can then consider transitioning to an endotracheal tube for a more definitive airway. In essence, while both Melody and Nick offer valid perspectives, the principle of minimizing interruptions to critical interventions makes the early use of a supraglottic airway a strategically sound initial approach.

Watch the full video here and leave a comment.

Don't forget to like and follow my IG, TikTok, YT, Facebook or Linkedin accounts.

FLASH SALE: 72 Hours Only!

3 Conferences For The Price Of 1

ResusX:2025 is gearing up to be the most anticipated resuscitation conference of 2025 but I wanted to give you something even more special for registering now. While you wait to attend September's conference, we are giving you access to ResusX:2024 and ResusX:2023. Register now and get LIFETIME access to both of these conferences plus 22 hours of CME / CEUs! 

Enjoy these conferences from your phone, tablet or desktop and watch the Rockstars of Resus go over high-yield topics that will improve your patient care. Each video is recorded in high-definition and comes with a lecture summary that you can download and take on the go. We've never offered this deal before and will only be running this for the next 72 hours...and once this deal is gone, it's GONE!

So register for the live conference in Philadelphia and experience short format, high-energy talks, interviews, procedure demoes, and debates. You'll also receive a swag bag filled with a t-shirt, mug, stickers, and a ton more. Food and snack are on us and you'll also be eligible to earn up to 20.0 CME or CEU credit. We got your trip covered with on-site parking and an available hotel block.

Today is your opportunity to take your resuscitation skills to the next level and save big with this special 3 for 1 conference deal. Remember, this ends in 72 hours so click on the link below to register.

 REGISTER NOW

In this episode, Dr. Richard Byrne tackles the challenges of intubating neurologically injured patients, sharing essential tips to enhance patient outcomes. Recorded live at ResusEM7, Dr. Byrne dives into the importance of managing oxygen and CO2 levels, selecting the right medications, and positioning the patient for optimal intubation success. He blends humor with practical advice, making this a must-listen episode for anyone looking to master airway management in critical situations. Tune in for expert insights that could make all the difference in your next emergency!

Check out this video of Dr. Derek Isenberg from ResusX:ReVolved now!

 Watch the Video Now!

When Seconds Count, Does IV or IO Really Matter?

When someone’s heart stops outside of a hospital, every second counts. Getting quick access to their veins or bones to deliver life-saving medicine is critical. Doctors and paramedics have long debated the best way to do this: through a vein (intravenous or IV access) or through the bone (intraosseous or IO access). A recent study dives into this debate, looking at whether one method truly gives patients a better chance of survival and recovery.

This research, involving nearly 1,500 patients, found that neither approach clearly beats the other when it comes to helping patients regain heart function. While the study couldn't definitively say if one method was better for longer-term survival, the main takeaway is reassuring: focusing on быстро starting resuscitation may be more important than how the access is obtained. This could simplify emergency procedures and help medical teams save precious time.

Here's my Takeaways:

• Finding: The probability of a clinically meaningful difference in return of spontaneous circulation between intraosseous and intravenous access was very low.
• Practice Impact: Results were uncertain for 30-day outcomes, with no strong evidence favoring one method over the other.
• Population: Adults experiencing non-traumatic out-of-hospital cardiac arrest.
• Limitation: Bayesian priors are inherently subjective.

Want to learn more? Read the full study "Intraosseous vs. Intravenous Access during Out-of-hospital Cardiac Arrest: A Bayesian Secondary Analysis of a Randomised Clinical Trial" by Vallentin et al. in Resuscitation.

Funnel plots are a visual tool to spot bias in meta-analyses — but they’re often misunderstood.

Here’s the practical explanation:

• Each point on a funnel plot represents a study. The X-axis is the effect size, the Y-axis is the study size (usually standard error).

• In theory, with no publication bias, the plot should look like an inverted funnel: larger studies cluster at the top near the true effect, smaller studies scatter at the bottom.

What you’re looking for:

• Symmetry: good.

• Asymmetry: potential publication bias or heterogeneity.

Caution: Not all asymmetry is due to bias. Small study effects, true heterogeneity, or poor methodological quality can also cause distortion.

In short: funnel plots are a screening tool, not a diagnosis.

➡️ Dive deeper into funnel plots here: Our Full Guide

Watch the May's Videos Now!

If you're an All-Access Member, you're in for some great content this month. We have FIVE videos hand-picked by our staff that are high-yield and our most highly watched. We're featuring

• Ducanto on "Bougie Down"
• Crager on "Reimagining Shock"
• Rezaie vs Swaminathan on "The Great CPR Debate"
• Gutierrez on "Peripheral Vasopressors"
• Rezaie on "TEG/ROTEM"

Each month we bring you fresh new content from the best of the best in resuscitation. If you're an All-Access member, go watch these videos NOW! If you're not, then sign up here.

Are you a member of ResusNation? For less than a cup of coffee, you can get even more content from CriticalCareNow. Digital teaching sessions, podcasts, free video lectures, grand rounds, and so much more can be your today. Come watch on replay all the content that CriticalCareNow does live. Check out the membership options below and decide the right one for you.

Do you want even more resus content anytime you want? For less than a cup of coffee, you can get even more content from @CriticalCareNow. Digital teaching sessions, free video lectures, grand rounds, and so much more can be your today. Come watch on replay all the content that @CriticalCareNow does live. 

Check out the membership options below and decide the right one for you.

 Get Access To The ResusNation Today!