Introduction efore the inception of coronary care units (CCU) myocardial infarction was treated with prolonged bed rest, digoxin and norepinephrine. Complications were frequent leading to a high mortality rate (25-30%). Gunnar Biorck of Stockhom wrote: "There are few diseases in the sphere of internal medicine where the average mortality during four to six weeks hospitalization is over 30%, and if the patients with shock are particularly considered, the figure is more than twice as large 1 "

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... k and colleagues in 1947 had resuscitated, by electric shock, a 14 year old boy in whom ventricular fibrillation developed during operation 2, 3 . Julian wrote on 5 May 1960, a 40 year old physician with a myocardial infarction collapsed on admission to the ward. A scalpel, which was poised to incise a cubital fossa in an adjacent catheterisation laboratory, was diverted to initiate a thoracotomy. After some minutes, help became available from the surgeons, who performed more effective cardiac massage until internal defibrillation could be carried out. The patient made an excellent cardiac recovery (he sustained some cerebral damage but survived for 23years). By a curious quirk of fate he was an alumnus of Johns Hopkins Hospital, and shortly after his recovery he showed us an article in the hospital journal describing closed chest cardiopulmonary resuscitation, which had been developed there by Kouwenhoven, Jude and Knickerbocker 4 .