This structure is derived from a Latin usage. Latin had a (to us) strange subordinating conjunction, quin, twhich was followed by a verb in the subjunctive. Instead of writing omnes sciunt (everybody knows) they would often write
Nemo est quin sciat
School kids were often advised by Latin teachers, trying to capture what exactly was going on grammatically in this upside down way of speaking, to translate it:
There is nobody but that he knows.
It is a sort of virtual double negative. 'But' has a usage as meaning 'except', as is mentioned in the Cambridge dictionary:
'But' meaning ‘except’:
But means ‘except’ when it is used after words such as all, everything/nothing, everyone/no one, everybody/nobody: …
But for + reason
But for is used to introduce the reason why something didn’t happen: …
All but meaning ‘almost completely’
In your example of this usage, "Who knows" stands for "nobody knows" We have all as children shrugged our shoulders and said "who cares?", meaning that "nobody cares". So what is meant is:
Who knows, , he might save your life again.