Defibrillator

Defibrillator . Device that produces a short-term electric shock , capable of stimulating the heart. Restore normal heart rate. There are external and implantable. Defibrillation is the definitive treatment for life-threatening cardiac arrhythmias , ventricular fibrillation , and pulseless ventricular tachycardia . Defibrillation involves delivering a therapeutic dose of electrical energy to the affected heart with a device called. Defibrillator depolarizes a critical mass of the heart muscle, ends the arrhythmia and allows normal sinus rhythm to be restored by the body’s natural pacemaker at the sinus node of the heart.

Defibrillators can be external, transvenous, or implanted, depending on the type of device used or needed. Some external units, known as DEA automatic external defibrillators, automate the diagnosis of treatable rhythms, so first responders or bystanders are able to successfully use with little, or in some cases not training at all.

Summary

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  • 1 Emergence
  • 2 History
    • 1 Implementation
  • 3 Risks of treatment
  • 4 types
    • 1 Automatic Defibrillator
    • 2 Portable Defibrillators
  • 5 Sources

Emergence

Defibrillation was first demonstrated in 1899 by Prevost and Batelli , two physiologists at the University of Geneva, Switzerland . They discovered that small electrical shocks could induce ventricular fibrillation in dogs , and that larger loads would reverse the condition.

The first use of a human being was in 1947 by Claude Beck , professor of surgery at Case Western Reserve University. Beck’s theory was that ventricular fibrillation often occurs in hearts, which were fundamentally healthy, in their terms Hearts are too good to die, and that there must be a way to save them. Beck first used the technique successfully on a 14-year-old boy who was undergoing surgery for a birth defect in his chest. The boy’s chest was surgically opened, and manual cardiac massage was performed for 45 minutes until the defibrillator arrived. Beck uses internal paddles on both sides of the heart, along with procainamide, an antiarrhythmic drug, and has managed to return from normal sinus rhythm.

These early defibrillators used alternating current from an electrical outlet, transformed from the available 110-240 volts on the line, to between 300 and 1,000 volts, with the heart exposed through paddle-type electrodes. The technique was often ineffective in reversing VF, while morphological studies showed damage to postmortem heart muscle cells . The nature of the AC machine with an oversized transformer also made these units very difficult to transport, and they tend to be large units on wheels.

History

Until the 1950s , defibrillation of the heart was only possible when the chest cavity was open during surgery . The technique used an alternating current from a source of 300 volts or more delivered to the sides of the exposed heart by means of paddle electrodes, where each electrode was a flat or slightly concave metal plate about 40 mm in diameter.

The closed chest defibrillator device that applies an alternating current of more than 1,000 volts, carried out by means of electrodes applied externally through the cage from the chest to the heart, was initiated by Dr. V. Eskin with the assistance of A. Klimov in Frunze, USSR, mid 1950s .

In 1959 Bernard Lown began the investigation of an alternative technique that included charging a capacitor bank of approximately 1000 volts with a charging capacity of 100 to 200 joules, then delivering the charge through an inductance to produce a damped sine wave. largely of finite duration (~ 5 milliseconds) in the heart by means of paddle electrodes. Lown’s work was brought to the clinical application by Berkovits Barouh engineer with his cardioverter.

Defibrillator_DESA_PARAMEDIC

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

Another novelty in defibrillation came with the invention of the implantable device, known as an ICD or implantable cardioverter defibrillator. This was the pioneer at Sinai Hospital in Baltimore by a team that included Stephen Heilman , Langer Alois , Lattuca Jack Mower Morton , Michel Mirowski , and Imran Mir , with the help of industrial collaborators Systems Intec from Pittsburgh. Mirowski teamed up with Mower and Staewen, and together they began their research in 1969 , but 11 years before it was their first patient. Similar development work was carried out by Schuder and colleagues at the University of Missouri.

The work began, despite doubts among leading experts in the field of arrhythmias and sudden death. There was no doubt that his ideas could become a clinical reality. In 1962 Bernard Lown introduced the DC external defibrillator. This device applies a direct current from a discharge capacitor through the chest wall in the heart to stop cardiac fibrillation. In 1972 , Lown said in Circulation magazine.

The very rare patient with frequent outbreaks of ventricular fibrillation is the best treatment in a coronary unit and is best served by an effective antiarrhythmic program or surgical correction of inappropriate coronary blood flow or ventricular malfunction. In fact, the implanted defibrillator system represents an imperfect solution looking for a possible and practical application. The problems to be overcome were the design of a system that would allow the detection of ventricular fibrillation or ventricular tachycardia. Despite the lack of financial support and scholarships, they persisted and the first device was implanted in February 1980 at Johns University Hopkins Hospital by Dr. Levi Watkins, Jr. Modern ICDs do not require a thoracotomy and possess pacemakers, cardioversion, and defibrillation capacity.

The invention of implantable units is very valuable for some people who suffer from regular heart problems, although in general it is only given to those who have already had a cardiac episode and in this way the life expectancy of patients with this disease is extended. suffering.

Implantation

Its implementation, today, has been greatly simplified. It is no longer necessary to open the chest; the electrode is placed through the veins and the generator is implanted superficially, below the clavicle similar to the placement of a pacemaker.

Treatment risks

Pain caused by electric shocks. The ICD has not yet automatically diagnosed arrhythmias in 100% of cases, as it sometimes confuses serious arrhythmias with other benign ones and delivers shocks unnecessarily. Therefore, its implantation is only recommended in patients with a high risk of malignant arrhythmias.

Types

  • Manual defibrillators

Defibrillator_REANIBEX_700

Defibrillator model REANIBEX 700

  • REANIBEX 700 portable defibrillator, high-performance equipment, truncated exponential biphasic wave. With the possibility of AED (semi automatic), external pacemaker, SpO2 (pulse oximetry), cable with 3 – 5 or 12 leads, posibility for electroluminescent screen ** EL of high technology. Weight 5.5 Kg. Measurements 31 x 19 x 25 cm. RECOMMENDED EQUIPMENT.
  • MRX model defibrillator
  • Defibrillator with pacemaker posibility, 12 leads, pulse oximetry, non-invasive pressures and Capnography.
  • CARDIO AID 200 defibrillator
  • Defibrillator with biphasic wave mode, manual operation and semi-automatic AED function with voice protocols. Integrated printer and transcutaneous external pacemaker. Pulse oximetry function integrated with NELLCOR technology. Network operation 220V and integrated rechargeable battery.
  • HEARTSTREAM XL defibrillator
  • Defibrillator with biphasic wave mode, AED and manual operation. Synchronized cardio version, alarms in HR limits and shockable rhythms, bright electroluminescent screen. Monitoring through defibrillation and disposable electrodes, can be supplied with pacemaker and pulse oximetry.
  • Semiautomatic
    • DESA PARAMEDIC Defibrillator + CPR Kit
    • Semi automatic defibrillator + RCP KIT, rechargeable battery, use with battery and 220V network (optional at 12V). Visualization of ECG wave, by means of included defibrillation electrodes or electrodes with 2 normal hoses (Optional), protocol by voice and text. Screen with retro lighting interactive LCD night light. RS232c connection for warnings to medical emergency systems. Supplied with; 2 sets of defibrillation electrodes (4 units) + 220V mains cable, Power adapter and battery charger, 1 integrated rechargeable long-life NI-Mh battery, equipment case with handles and shoulder strap, accessory case and RCP Kit. The RCP Kit is made up of: Mouth – mouth mask with non-return valve + sterile razor + nitrile gloves + alcohol wipe + clothing scissors + KIT RCP transport cover. Maximum performance equipment with the best value for money. RECOMMENDED EQUIPMENT Measures 30 x 25 x 9 cm. Weight 3 Kg.
    • DESA PAD Defibrillator + CPR Kit
    • Semi-automatic defibrillator, truncated exponential biphasic wave, maintenance-free battery for a minimum of 120 shocks, voice protocol, integral case included. Automatic download correction, very easy to use in 3 steps, Weight 2.2 Kg. (The most economical). Ideal for use in buildings, airports, companies, ambulances, etc … This equipment is supplied with its transport case + The RCP Kit is made up of: Mouth Mask – mouth with non-return valve + sterile razor + nitrile gloves + wipe alcohol + clothing cut scissors + CPR KIT carrying case + 2 pairs of Adult electrodes.
    • DESA REANIBEX 200 Defibrillator + CPR Kit
    • Semi automatic defibrillator, truncated exponential biphasic wave, battery for more than 300 shocks, ECG wave display, voice and text protocol, event memory, case option. Screen with retro lighting night light are automatic light sensor. adjustable defibrillation protocols. Supplied with the RCP Kit, it is made up of: Mouth Mask – mouth with non-return valve + sterile razor + nitrile gloves + alcohol wipe + scissors for short clothing + KIT RCP transport case Measures 30 x 28 x 9 cm. Weight 2.5 Kg.
    • Defibrillator DESA HS + CPR Kit semi automatic equipment, without screen and without ECG waveform display. This is the simplest and cheapest equipment on the market. Acoustic warnings by voice. TURN ON – COLLECT ELECTRODES – DEFIBRILLATE, if necessary. Supplied with the RCP Kit, it is made up of: Mouth Mask – mouth with non-return valve + sterile razor + nitrile gloves + alcohol wipe + short clothing scissors + KIT RCP transport bag

Defibrillator_FR3

DESA FR3 Defibrillator + CPR Kit

  • New HEARTSTART FR3 defibrillator. It has a high resolution color screen and real-time ECG presentation and written messages. So it performs automatic analyzes of the patient’s ECG, as well as the connection impedance. In addition, it includes a new SMART CPR algorithm for analysis and recommendation on the advisability of starting cardiac arrest treatment with defibrillation or with CPR followed by defibrillation. It has the ability to program the equipment (not by the user) to allow its use in manual mode. Its battery is non-rechargeable, maintenance-free, with years of autonomy in standby mode or 300 downloads or 12 hours of monitoring. It weighs 1.60 kg and its dimensions are; 6.9 x 13.5 x 22.1 cm. The key can be incorporated that allows the use of the equipment with pediatric patients and through the same adhesive electrodes. Supplied with the RCP Kit, it consists of: Mouth Mask – mouth with non-return valve + sterile razor + nitrile gloves + alcohol wipe + clothing scissors + KIT RCP transport cover.
  • DESA FRX Defibrillator + CPR Kit this equipment is designed for those people who arrive at the places in the first place (emergency technicians, police officers, first responders), and who need intuitive equipment, easy to use, but also robust, and prepared for the circumstances on the ground. Supplied with an RCP Kit, it is made up of: Mouth Mask – mouth with non-return valve + sterile razor + nitrile gloves + alcohol wipe + clothing short scissors + KIT RCP transport cover.
  • Defibrillation electrodes We have a wide range of defibrillation electrodes, for almost all brands on the market, among others. Philips, HP, Zoll, Physio Control, Code Mascater, FR2, Reanibex, etc … We have both adult and pediatric models.

Automatic defibrillator

Automatic defibrillator

It has been known for some time that through electrodes, in close contact with the heart, the signal can be obtained that allows us to know the electrical activity of this muscle and, therefore, diagnose arrhythmias from within. This gave rise to the invention, in the 1980s, of implantable defibrillators, devices that not only diagnose rapid arrhythmias but apply enough energy from within the body to defibrillate the heart. Defibrillators are expensive, somewhat heavy and space-consuming devices. In addition, its dissemination raises the problem of personnel who know how to diagnose an arrhythmia. To circumvent this problem, semi-automatic defibrillators have emerged that when connecting the cables to the individual’s skin tell us whether or not they have an arrhythmia that requires defibrillation. These devices can be used by non-medical personnel, such as restrooms or firefighters.

Portable defibrillators

Portable_Debifrilator

A major advance was the introduction of portable defibrillators used outside of the hospital. This was started in the 1960s by Prof. Frank Pantridge in Belfast. Today portable defibrillators are some of the many very important tools performed by ambulances . They are the only proven way to resuscitate a person who has had cardiac arrest not witnessed by EMS who is still in ventricular fibrillation or persistent ventricular tachycardia upon arrival of prehospital providers.

Gradual improvements in the design of defibrillators, in part based on work to develop implanted versions (see below), have led to the availability of automated external defibrillators. These devices can analyze heart rate by themselves, diagnose shock rhythms, and treat burden. This means that no clinical skill is required in its use, allowing lay people to respond to emergencies effectively.

 

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