Defibrillator History - First Demonstrated by Jean-Louis Prévost and Frederic Batelli

DEFIBRILLATOR

History of Defibrillator

1899 Defibrillation was first demonstrated by Jean-Louis Prévost and Frederic Batelli, two physiologists from University of Geneva, Switzerland.

1933 Dr Albert Hyman (heart specialist at the Beth Davis Hospital of New York City) and C. Henry Hyman (an electrical engineer) invented the Hyman Otor were a hollow needle is used to pass an insulated wire to the heart area to deliver the electrical shock. The hollow steel needle being one end of the circuit and the insulated wire the other end.

1947 The first use of fibrillator on a human was administered by Claude Beck, professor of surgery at Case Western Reserve University. Beck first used the technique successfully on a 14 year old boy who was being operated on for a congenital chest defect. The boy's chest was surgically opened, and manual cardiac massage was undertaken for 45 minutes until the arrival of the defibrillator. Beck used internal paddles on either side of the heart, along with procainamide, an antiarrhythmic drug, and achieved return of normal sinus rhythm.

These early defibrillators used the alternating current from a power socket, transformed from the 110-240 volts available in the line, up to between 300 and 1000 volts, to the exposed heart by way of 'paddle' type electrodes. The technique was often ineffective in reverting VF while morphological studies showed damage to the cells of the heart muscle post mortem. The nature of the AC machine with a large transformer also made these units very hard to transport, and they tended to be large units on wheels.

1950s Defibrillation of the heart was possible only when the chest cavity was open during surgery. The technique used an alternating current from a 300 or greater volt source delivered to the sides of the exposed heart by 'paddle' electrodes where each electrode was a flat or slightly concave metal plate of about 40 mm diameter. The closed-chest defibrillator device which applied an alternating current of greater than 1000 volts, conducted by means of externally applied electrodes through the chest cage to the heart, was pioneered by Dr V. Eskin with assistance by A. Klimov in Frunze, USSR (today known as Bishkek, Kyrgyzstan)

1959 Bernard Lown commenced research into an alternative technique which involved charging of a bank of capacitors to approximately 1000 volts with an energy content of 100-200 joules then delivering the charge through an inductance such as to produce a heavily damped sinusoidal wave of finite duration (~5milliseconds) to the heart by way of paddle electrodes. The work of Lown was taken to clinical application by engineer Barouh Berkovits with his "cardioverter".

The Lown waveform, as it was known, was the standard for defibrillation until the late 1980s when numerous studies showed that a biphasic truncated waveform (BTE) was equally efficacious while requiring the delivery of lower levels of energy to produce defibrillation. A side effect was a significant reduction in weight of the machine. The BTE waveform, combined with automatic measurement of transthoracic impedance is the basis for modern defibrillators.

1960s A major breakthrough was the introduction of portable defibrillators used out of the hospital. This was pioneered by Prof. Frank Pantridge in Belfast. Today portable defibrillators are among the many very important tools carried by ambulances. They are the only proven way to resuscitate a person who has had a cardiac arrest unwitnessed by EMS who is still in persistent ventricular fibrillation or ventricular tachycardia at the arrival of pre-hospital providers.

1962 Bernard Lown introduced the external DC defibrillator. This device applied a direct current from a discharging capacitor through the chest wall into the heart to stop heart fibrillation.

1969 A further development in defibrillation came with the invention of the implantable device, known as an implantable cardioverter-defibrillator (or ICD). This was pioneered at Sinai Hospital in Baltimore by a team that included Stephen Heilman, Alois Langer, Jack Lattuca, Morton Mower,Michel Mirowski, and Mir Imran, with the help of industrial collaborator Intec Systems of Pittsburgh. Mirowski teamed up with Mower and Staewen, and together they commenced their research

1972 Lown stated in the journal Circulation -- "The very rare patient who has frequent bouts of ventricular fibrillation is best treated in a coronary care unit and is better served by an effective antiarrhythmic program or surgical correction of inadequate coronary blood flow or ventricular malfunction. In fact, the implanted defibrillator system represents an imperfect solution in search of a plausible and practical application.

February 1980 Despite the lack of financial backing and grants, they persisted and the first device was implanted at Johns Hopkins Hospital by Dr. Levi Watkins, Jr. Modern ICDs do not require a thoracotomy and possess pacing, cardioversion, and defibrillation capabilities.

1980s External defibrillators delivered a Lown type waveform which was a heavily damped sinusoidal impulse having a mainly uniphasic characteristic. Biphasic defibrillation alternates the direction of the pulses, completing one cycle in approximately 10 milliseconds. Biphasic defibrillation was originally developed and used for implantable cardioverter-defibrillators. When applied to external defibrillators, biphasic defibrillation significantly decreases the energy level necessary for successful defibrillation, decreasing the risk of burns and myocardial damage.

Ventricular fibrillation (VF) could be returned to normal sinus rhythm in 60% of cardiac arrest patients treated with a single shock from a monophasic defibrillator. Most biphasic defibrillators have a first shock success rate of greater than 90%.

Use of Defibrillator

Defibrillator is an apparatus used to produce defibrillation by application of brief electroshock to the heart, directly or through electrodes placed on the chest wall. Defibrillation is a common treatment for life-threatening cardiac arrhythmias, ventricular fibrillation and pulseless ventricular tachycardia. Defibrillation consists of delivering a therapeutic dose of electrical energy to the affected heart with a device called a