The History Of Defibrillation
Defibrillation is the therapeutic use of electrical energy to shock the heart to improve the heart's operations
. The shock depolarizes the heart muscle, terminates the arrhythmia, and helps the heart begin a normal heart beat dependent on the sinus rhythm, which is the body's natural pacemaker.
Sometimes defibrillators can be placed internally if needed, but most of the time it is used outside the body. Automated External Defibrillators (AEDs) can diagnose the treatable rhythms.
This allows bystanders to use them successfully with very little or no training. Defibrillation was first used in 1899 by Prevost and Batelli in Switzerland at the University of Geneva.
While they were experimenting on dogs they discovered that small electric shocks would start ventricular fibrillation. Likewise, larger shocks would stop ventricular fibrillation.
Defibrillation was not used on a human until 1947 by Claude Beck. At the time Claude Beck was a professor of surgery at Case Western Reserve University.
Beck's philosophy was that "Hearts are too good to die" and that ventricular fibrillation was occurring in hearts that were healthy and there must be a way to stop it and save these people. Beck operated on a 14 year old boy for congenital chest defect and after opening his chest, Beck performed manual cardiac massage for 45 minutes while he waited for the defibrillator to arrive.
Beck then used internal paddles on either side of the heart in combination with procainamide, an antiarrhythmic drug, to get the boy's heart to start on a normal sinus rhythm. This primitive defibrillator used alternating current from a power socket.
The shock could be set between 300 and 1000 volts. For the most part, ventricular fibrillation was unaffected by this defibrillator and further studies showed it damaged cells of the heart muscle.
The machine required a large transformer that made the defibrillator very hard to move to a new location. It was not until the 1950s that this method was applied when the chest was not open due to surgery.
In the closed-chest defibrillator procedure more than 1000 volts were applied to the chest through external electrodes. This machine was created by Dr. B. Esking in the USSR.
Later the Lown waveform was developed and was used as the standard for defibrillation until the 1980s. At this time it was discovered that biphasic truncated waveform (BTE) was as effective as the Lown waveform, but used lower levels of energy to perform defibrillation.
This machine was also significantly smaller than any previous machines. BTE waveform and the automatic measurement of transthoracic impedance make up the modern defibrillator.
One of the biggest improvements to the defibrillator since that time was the creation of the portable defibrillator. This allowed the method to be taken out of hospitals and put in modern ambulances.
These defibrillators are the only known way to resuscitate someone who has had an cardiac arrest while not under the supervision of EMS personnel and who is still suffering from ventricular fibrillation when the medical personnel arrive.
Other small improvements of the defibrillator include the development of implanted models that analyze heart rhythms and diagnose the shock-able rhythms and apply treatment. These can be used by people with no medical training.
Many public areas are beginning to place brightly colored AEDs for public use near the entrance of buildings. A buzzer will alert trained on-site personnel to the removal, but will not call emergency personnel.
However, an ambulance should be called immediately to assist the unconscious person. As emergency personnel may be too far away, these AEDs can save lives.
Some areas have designated community first responders, who are volunteers trained in using an AED. They are on emergency call and will visit victims in their area when they need to be treated.
Defibrillation has revolutionized the way cardiac arrests are treated. These machines have saved thousands of lives multiple times throughout the years since they have been developed.
by: Terry Daniels
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