AED自動體外除顫器歷史

The Complete History of AEDs & External Defibrillation

AED與體外除顫的完整歷史

In 1775, a Dutch veterinarian named Peter Abildgaard used electricity to stop—and then revive—the heart of a chicken, thus proving once and for all that electricity could be used to manipulate heart rhythms. Ever since then, scientists have been working diligently to master the art of defibrillation, the process of using controlled electric shocks to restore normal heart function in cardiac arrest sufferers.
1775年，一位名叫Peter Abildgaard的荷蘭獸醫(yī)用電停止了一只雞的心臟，然后使其蘇醒，從而一勞永逸地證明了電可以用來操縱心律。從那時起，科學(xué)家們一直在努力工作，以掌握除顫的藝術(shù)，即使用受控電擊來恢復(fù)心臟驟停患者的正常心臟功能。

Today’s automated external defibrillators are capable of assessing heart rhythms, coaching users in real time, and administering automatic or semi-automatic shocks. We take for granted how intuitive these devices are, but it’s been a long and complicated journey from zapping chickens to defibrillation-on-demand. The complete history of AEDs is complex and compelling.
今天的自動體外除顫器能夠評估心律，實時指導(dǎo)用戶，并進行自動或半自動的電擊。我們認為這些設(shè)備的直觀性是理所當(dāng)然的，但從電擊雞到按需除顫，這是一個漫長而復(fù)雜的過程。AED的完整歷史是復(fù)雜而令人信服的。

The Early Days of Defibrillation in Animals – 1899-1946

早期的動物除顫 - 1899-1946年

Starting around the turn of the 20th century, cardiac arrest became a leading killer nationwide. Ironically, the condition became common because people were getting healthier. That is, they were suddenly living long enough to develop debilitating heart disease. Infectious diseases no longer ruled the day.
大約從20世紀初開始，心臟驟停成為全國范圍內(nèi)的一個主要殺手。具有諷刺意味的是，這種情況變得普遍是因為人們越來越健康。也就是說，他們突然活得足夠長，以至于患上了衰弱的心臟疾病。傳染性疾病不再主宰時代。

As cardiac arrest became a growing worldwide concern, scientists concerned themselves with how to revive a failing heart. Expanding on the animal research conducted by earlier medical professionals, two physiologists at the University of Geneva—Jean-Louis Prevost and Frederic Batelli—came together in 1899 and conducted a series of successful defibrillation experiments on dogs. Though they weren’t the first researchers to stop and restart an animal’s heart, they were instrumental in identifying the role of ventricular fibrillation as a cause of cardiac arrest.
隨著心臟驟停成為全世界日益關(guān)注的問題，科學(xué)家們關(guān)注的是如何使衰竭的心臟復(fù)蘇。1899年，日內(nèi)瓦大學(xué)的兩位生理學(xué)家Jean-Louis Prevost和Frederic Batelli在早期醫(yī)學(xué)專家進行的動物研究的基礎(chǔ)上，一起對狗進行了一系列成功的除顫實驗。盡管他們不是第一個停止和重新啟動動物心臟的研究人員，但他們在確定心室顫動作為心臟驟停的原因方面發(fā)揮了重要作用。

In the 1940s, two Soviet doctors, Dr. Naum Lazarevich Gurvich and Dr. G.S. Yuniev, expanded on this knowledge and proposed the first defibrillation waveform. This waveform, now referred to as biphasic waveform technology, is used even today in some of the world’s best AEDs. Biphasic waveforms deliver shock via two separate vectors, reducing the defibrillation threshold and improving patient outcomes.
20世紀40年代，兩位蘇聯(lián)醫(yī)生Naum Lazarevich Gurvich博士和G.S. Yuniev博士對這一知識進行了擴展，提出了第一個除顫波形。這種波形，現(xiàn)在被稱為雙相波形技術(shù)，甚至在今天被用于一些世界上最好的AED中。雙相波形通過兩個獨立的矢量進行電擊，降低了除顫閾值，改善了病人的治療效果。

In 1946, Gurvich and Yuniev put their theories into practice and completed the first closed-chest defibrillation on a mammal—a dog, specifically. In other words, they were able to revive the animal by applying electrodes to the surface of the chest without opening the chest cavity to access the heart organ directly. This was a huge step forward.
1946年，Gurvich和Yuniev將他們的理論付諸實踐，完成了對哺乳動物--特別是狗--的首次閉合式胸部除顫術(shù)。換句話說，他們能夠通過在胸部表面施加電極來使動物蘇醒，而不需要打開胸腔直接接觸心臟器官。這是一個巨大的進步。

The First Defibrillation in Humans – 1947-1950

人類首次除顫 - 1947-1950年

Less than a year after Gurvich and Yuniev captured the world’s attention with the first closed-chest defibrillation on a mammal, an American cardiac surgeon named Claude Beck would prove the viability of defibrillating human beings.
在Gurvich和Yuniev以首次對哺乳動物進行閉胸除顫吸引了全世界的注意力后不到一年，一位名叫Claude Beck的美國心臟外科醫(yī)生將證明為人類除顫的可行性。

For Beck, the mission was personal. He had been heavily invested in fibrillation research since the late 1920s, when he lost a patient to ventricular fibrillation. Throughout the 1930s and ‘40s, he studied and experimented with methods of improving heart circulation and treating fibrillation with manual heart massages.
對Beck來說，這個任務(wù)是個人的。自20世紀20年代末以來，他一直大力投入顫動研究，當(dāng)時他因心室顫動失去了一名病人。在整個20世紀30年代和40年代，他研究并試驗了改善心臟循環(huán)和用手動心臟按摩治療顫動的方法。

He became interested in electrical defibrillation after studying the successful animal experiments of colleagues like Carl J. Wiggers at Western Reserve (now Case Western Reserve University). He was convinced that such experiments could be replicated in humans and perfected to save lives.
在研究了Carl J. Wiggers等同事在西區(qū)（現(xiàn)在的凱斯西區(qū)大學(xué)）的成功動物實驗后，他對電除顫產(chǎn)生了興趣。他相信這種實驗可以在人類身上復(fù)制并完善，以拯救生命。

In 1947, Beck and a group of investigators at the University Hospitals in Cleveland, Ohio, completed the first open-heart defibrillation on a human being. The patient, Richard Heyard, was a 14-year-old boy being treated for a congenital chest defect. His heart entered ventricular fibrillation near the end of his procedure, and manual massage did nothing to stop the problem. With no other options, Beck connected two electrodes to Heyard’s open heart and shocked it four times at 110 volts. The heart rhythm was restored, and Heyard made a complete recovery.
1947年，Beck和俄亥俄州克利夫蘭大學(xué)醫(yī)院的一組調(diào)查人員完成了對一個人的首次開胸除顫手術(shù)。患者Richard Heyard是一個14歲的男孩，正在接受先天性胸部缺陷的治療。他的心臟在手術(shù)接近尾聲時進入室顫，而手動按摩并不能阻止這一問題。在沒有其他選擇的情況下，Beck將兩個電極連接到Heyard的開放心臟上，并以110伏的電壓電擊了四次。心律得到了恢復(fù)，Heyard完全康復(fù)了。

The story made worldwide news headlines. One such headline read, “How Science Brings Americans Back from the Dead.” From that point on, Beck dedicated himself to improving electrical defibrillation for use on human beings. He developed the original prototype defibrillator, which—though monumental for its time—was little more than a large wooden box with two metal electrodes attached.
這個故事成為全球新聞頭條。其中一個標(biāo)題是："科學(xué)如何讓美國人起死回生"。從那時起，Beck致力于改進用于人類的電除顫技術(shù)。他開發(fā)了最初的除顫器原型，雖然在當(dāng)時具有紀念意義，但它只不過是一個大木箱，上面有兩個金屬電極。

Beck and his colleagues would ultimately go on to develop some of the CPR practices that are still used today. They trained over 3,000 doctors and nurses in CPR and ultimately developed a CPR course for laypersons as well. His work represents a turning point in the history of AEDs.
Beck和他的同事最終發(fā)展了一些至今仍在使用的心肺復(fù)蘇術(shù)。他們對3000多名醫(yī)生和護士進行了心肺復(fù)蘇術(shù)培訓(xùn)，并最終為非專業(yè)人士開發(fā)了心肺復(fù)蘇術(shù)課程。他的工作代表了AED歷史上的一個轉(zhuǎn)折點。

The First Portable External Defibrillators – 1950-1956

第一臺便攜式體外除顫器--1950-1956年

While Beck and his colleagues worked on improving defibrillation in hospitals, another doctor, William Kouwenhoven, was working on developing a more portable solution. Kouwenhoven was the dean of the School of Engineering at Johns Hopkins University, and he was known for his successful open-heart defibrillation experiments on dogs. In the early 1950s, he started experimenting with DC-powered portable defibrillator designs. At the time, though, there were no DC batteries powerful enough to create the necessary charge for closed-heart defibrillation.
當(dāng)Beck和他的同事們致力于改善醫(yī)院的除顫工作時，另一位醫(yī)生 William Kouwenhoven正致力于開發(fā)一種更便攜的解決方案。Kouwenhoven是約翰霍普金斯大學(xué)工程學(xué)院的院長，他因在狗身上成功進行開顱除顫實驗而聞名。在20世紀50年代初，他開始試驗直流電驅(qū)動的便攜式除顫器設(shè)計。但在當(dāng)時，沒有足夠強大的直流電池來產(chǎn)生閉合心臟除顫的必要電荷。

In 1951, Kouwenhoven started exploring AC power instead, and he was finally on his way to developing a sustainable portable defibrillator. By 1957, he finished work on one of the original closed-chest defibrillators for human use. The device used AC electricity to deliver 480-volt shocks safely to the adult heart. The only problem was that it weighed over 250 pounds (120 kg), which made it completely impractical as a portable device. Still, Kouwenhoven and his team kept innovating, and by 1961, they developed the first truly portable defibrillator. It weighed about 45 pounds and was capable of fitting into a small suitcase.
1951年，Kouwenhoven開始探索用交流電代替，他終于走上了開發(fā)可持續(xù)便攜式除顫器的道路。到1957年，他完成了供人使用的原始閉合式胸部除顫器之一的工作。該設(shè)備使用交流電向成人心臟安全地提供480伏的電擊。唯一的問題是它的重量超過250磅（120公斤），這使得它作為一個便攜式設(shè)備完全不實用。盡管如此，Kouwenhoven和他的團隊仍然不斷創(chuàng)新，到1961年，他們開發(fā)了第一個真正的便攜式除顫器。它重約45磅，能夠裝入一個小手提箱。

Though Kouwenhoven’s contributions were monumental, his legacy would ultimately be overshadowed by that of Paul Zoll, one of his contemporaries who was also researching portable defibrillation. Zoll, who’s recognized today as the Father of Modern Cardiac Therapy, became interested in treating ventricular fibrillation in 1947. Like Beck before him, his interest was ignited after he lost a patient to cardiac arrest.
盡管Kouwenhoven的貢獻是不朽的，但他的遺產(chǎn)最終會被與他同時代的Paul Zoll所代替，后者也在研究便攜式除顫儀。今天被公認為現(xiàn)代心臟治療之父的Zoll在1947年開始對治療心室顫動感興趣。與他之前的Beck一樣，他的興趣是在他因心臟驟停而失去一個病人之后被點燃的。

His radical ideas—like his preference for closed-chest over open-chest resuscitation and his use of direct current countershock to stimulate heart activity—were met with resistance and even ridicule in the 1950s, but these techniques would ultimately become the hallmarks of external defibrillation practices used even today.
他的激進思想--如他傾向于閉胸搶救而不是開胸搶救，以及他使用直流電擊來刺激心臟活動--在20世紀50年代遭到了抵制甚至嘲笑，但這些技術(shù)最終成為甚至今天使用的體外除顫做法的標(biāo)志。

In 1952, Zoll used external defibrillation to resuscitate two cardiac arrest patients. Though the first patient only survived 20 minutes, the second lived for nearly a year after being revived. Zoll continued to develop his techniques, and by 1956, he developed a new closed-chest method of safely defibrillating patients with a much larger shock, as much as 750 volts.
1952年，Zoll使用體外除顫器搶救了兩名心臟驟?；颊?。雖然第一個病人只活了20分鐘，但第二個病人在被救活后活了近一年。Zoll繼續(xù)發(fā)展他的技術(shù)，到1956年，他開發(fā)了一種新的閉合胸腔的方法，用更大的沖擊力安全地給病人除顫，沖擊力高達750伏。

Zoll and Kouwenhoven developed their closed-chest devices within months of one another, and while both doctors changed the face of cardiac treatment, it’s Zoll’s once-controversial techniques that have stood the test of time and influenced generations of cardiac researchers. In 1980, Zoll co-founded ZOLL Medical, and ZOLL AEDs continue to raise the bar even today.
Zoll和Kouwenhoven在幾個月內(nèi)相繼開發(fā)了他們的胸腔閉合設(shè)備，雖然兩位醫(yī)生都改變了心臟治療的面貌，但Zoll曾經(jīng)有爭議的技術(shù)經(jīng)受住了時間的考驗，影響了幾代心臟研究人員。1980年，Zoll與他人共同創(chuàng)辦了ZOLL醫(yī)療公司，而ZOLL自動體外除顫器直到今天仍在不斷提高標(biāo)準。

The First Portable Defibrillators in the Field – 1965-1969

第一批現(xiàn)場便攜式除顫器 - 1965-1969年

Though Zoll and Kouwenhoven experimented with portable defibrillation in the 1950s, the world wouldn’t see such a device in the field until the mid-’60s. In 1965, Irish physician and cardiologist Frank Pantridge developed a 150-pound portable defibrillator for use in a Belfast ambulance. It was powered by car batteries.
盡管 Zoll和Kouwenhoven在20世紀50年代進行了便攜式除顫的實驗，但直到60年代中期，世界上才會看到這種設(shè)備出現(xiàn)在現(xiàn)場。1965年，愛爾蘭醫(yī)生和心臟病專家Frank Pantridge開發(fā)了一個150磅重的便攜式除顫器，用于Belfast的救護車。它由汽車電池供電。

By 1968, Pantridge developed an improved portable defibrillator that weighed less than 7 pounds and was powered by a miniature capacitor designed by NASA. This small, lightweight device is often considered the first true portable AED on account of its size and power.
到1968年，Pantridge開發(fā)了一種改進的便攜式除顫器，它的重量不到7磅，由美國宇航局設(shè)計的微型電容器供電。這種小而輕的設(shè)備由于其尺寸和功率，通常被認為是第一個真正的便攜式自動除顫器。

Starting as early as the late 1960s, Pantridge’s innovative designs were adopted in hospitals and ambulances throughout the world. Surprisingly, though, the technology caught fire internationally before it became a mainstay of his own homeland. Defibrillators wouldn’t become standard in all UK ambulances until 1990.
早在20世紀60年代末開始，Pantridge的創(chuàng)新設(shè)計就被世界各地的醫(yī)院和救護車所采用。然而，令人驚訝的是，這項技術(shù)在成為他自己國家的主流之前，就已經(jīng)在國際上火了。除顫器直到1990年才成為英國所有救護車的標(biāo)準配置。

The Modern History of AEDs – 1978 to the Present

AED的現(xiàn)代史--1978年到現(xiàn)在

Even as portable defibrillators became a reality in the 1960s, it would be years before such devices would be available to the general public. There were understandable concerns about entrusting untrained laypersons with equipment capable of emitting hundreds of volts of electrical shock to the heart.
即使便攜式除顫器在20世紀60年代成為現(xiàn)實，但這種設(shè)備要在數(shù)年后才會向普通公眾開放。對于將能夠向心臟發(fā)出數(shù)百伏電擊的設(shè)備委托給未經(jīng)訓(xùn)練的普通人，人們的擔(dān)心是可以理解的。

The solution would come from a group of colleagues in Portland, Oregon, in 1978. Physicians Arch Diack and W. Stanley Welborn collaborated with engineer Robert Rullman with the goal of developing a foolproof portable defibrillator that bystanders could safely use in an emergency.
1978年，俄勒岡州波特蘭市的一群同事提出了解決方案。醫(yī)生Arch Diack和W. Stanley Welborn與工程師Robert Rullman合作，目的是開發(fā)一種萬無一失的便攜式除顫器，讓旁觀者在緊急情況下可以安全使用。

And so they developed the Heart-Aid, the first commercially available AED designed for minimally trained lay-providers. The device contained a specially designed sensor that an operator could insert into the patient’s airway. The sensor could detect if a patient was breathing (and therefore not in cardiac arrest) and would then cease operations. A computer chip could also detect heart rate activity from the electrode and determine if a shockable rhythm was present.
因此，他們開發(fā)了Heart-Aid，這是第一個為訓(xùn)練有素的非專業(yè)人員設(shè)計的商業(yè)化AED。該設(shè)備包含一個特別設(shè)計的傳感器，操作者可以將其插入病人的氣道。該傳感器可以檢測病人是否在呼吸（因此不是心臟驟停），然后停止操作。一個計算機芯片也可以從電極檢測心率活動，并確定是否存在可沖擊的心律。

An adhesive electrode pad made the device safe for untrained users, as it allowed the user to take a hands-off approach and avoid the kind of accidental shock that could result from improperly operating a paddle. Finally, the device was equipped with real-time voice coaching, so an untrained user could listen along and deliver emergency treatment.
一個粘性電極墊使該設(shè)備對未受過訓(xùn)練的用戶來說是安全的，因為它允許用戶采取不動手的方式，避免因操作不當(dāng)可能導(dǎo)致的那種意外電擊。最后，該設(shè)備配備了實時語音輔導(dǎo)，因此未經(jīng)訓(xùn)練的用戶可以聽從并提供緊急治療。

Although the Heart-Aid never became a major commercial success, it set the foundation for the modern automated external defibrillator. Every AED currently in production relies on conventions that originated with this device, including the use of adhesive pads, heart rhythm assessment, and voice coaching.
盡管Heart-Aid從未取得重大的商業(yè)成功，但它為現(xiàn)代自動體外除顫器奠定了基礎(chǔ)。目前正在生產(chǎn)的每臺自動體外除顫器都依賴于源于該設(shè)備的慣例，包括使用膠墊、心律評估和語音指導(dǎo)。

The history of AEDs is still unfolding. Today, most devices weigh around 3 pounds—a far cry from the 250-pound “portable” defibrillator developed by William Kouwenhoven. Many deliver automatic shocks, and most are available for home use. They’re low-maintenance, easy to operate, and constantly improving as new technologies emerge.
自動除顫器的歷史仍在展開。今天，大多數(shù)設(shè)備的重量在3磅左右--與William Kouwenhoven開發(fā)的250磅的 "便攜式 "除顫器相差甚遠。許多設(shè)備都能提供自動電擊，而且大多數(shù)都可以在家里使用。它們維護成本低，易于操作，并隨著新技術(shù)的出現(xiàn)不斷改進。

If you ever need to use one of these devices, you can thank the tireless research and experimentation of innovators like William Kouwenhoven, Claude Beck, Frank Pantridge, and Paul Zoll.
如果你需要使用這些設(shè)備，你可以感謝William Kouwenhoven、Claude Beck、Frank Pantridge和Paul Zoll等創(chuàng)新者的不懈研究和實驗。

信息來源：CPR1 LLC.