Organization of a Neuroscience Critical Care Unit Historical Perspectives and Vision for the Future

Medical historians date the beginning of neurocritical care back to the 16th century. In delineating the history of critical care, some quote biblical passages, philosophers, and historians, and ethicists indicate historically early end-of-life discussions, and attempts at resuscitation and artificial ventilation (2). Pictorial illustrations of early artificial respiration devices and descriptions of resuscitation practices appear primitive and comical (3). However, these devices and methods set the foundation for significant advances in the 19th century. In the first half of the 20th century, when neurologists were challenged by the poliomyelitis epidemics, they had the groundwork for the first large-scale use of mechanical ventilation (4). Modern neurological intensive care began with the use of respiratory care principles established during European poliomyelitis epidemics and expanded into a broad field that encompasses all acute and serious aspects of neurological and neurosurgical disease (5). As the development of neurocritical care was defined by historical events, so too were the roles of neurosurgeons, neurologists, and neuroanesthesiologists in the field. When the American Academy of Neurology (AAN) was founded, most poliomyelitis victims primarily received their care from neurologists. Dr. A. B. Baker, a founding AAN member and vocal proponent of neurosciences, strongly advocated for the role of neurologists in the care of polio victims and other critically ill neurological patients (4). During that time, the issue of infectious disease as the precipitating factor or secondarily related to the neurologic critical illness was debated. Baker contended that neurologists of his era provided more comprehensive care than infectious disease specialists. Because of patient acuity, early 20th century neurology practices required critical care medicine. Neurologists performed tracheotomies, rigid bronchoscopes, and other minor surgical procedures (4). Early neurologists played an active role in the instruction of critical care skills. Neurologists not only played an active role in neurocritical care training and development of neurocritical care as a specialty, but they also played key roles in growth of general critical care. In the 1970s, Dr. David Jackson, a neurologist at Case Western Reserve University, directed one of the first general critical