The Complete History of AEDs & External Defibrillation
AED与体外除颤的完整历史
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的荷兰兽医用电停止了一只鸡的心脏，然后使其苏醒，从而一劳永逸地证明了电可以用来操纵心律。从那时起，科学家们一直在努力工作，以掌握除颤的艺术，即使用受控电击来恢复心脏骤停患者的正常心脏功能。
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.
今天的自动体外除颤器能够评估心律，实时指导用户，并进行自动或半自动的电击。我们认为这些设备的直观性是理所当然的，但从电击鸡到按需除颤，这是一个漫长而复杂的过程。AED的完整历史是复杂而令人信服的。
The Early Days of Defibrillation in Animals – 1899-1946
早期的动物除颤 - 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.
大约从20世纪初开始，心脏骤停成为全国范围内的一个主要杀手。具有讽刺意味的是，这种情况变得普遍是因为人们越来越健康。也就是说，他们突然活得足够长，以至于患上了衰弱的心脏疾病。传染性疾病不再主宰时代。
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.
随着心脏骤停成为全世界日益关注的问题，科学家们关注的是如何使衰竭的心脏复苏。1899年，日内瓦大学的两位生理学家Jean-Louis Prevost和Frederic Batelli在早期医学专家进行的动物研究的基础上，一起对狗进行了一系列成功的除颤实验。尽管他们不是第一个停止和重新启动动物心脏的研究人员，但他们在确定心室颤动作为心脏骤停的原因方面发挥了重要作用。
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世纪40年代，两位苏联医生Naum Lazarevich Gurvich博士和G.S. Yuniev博士对这一知识进行了扩展，提出了第一个除颤波形。这种波形，现在被称为双相波形技术，甚至在今天被用于一些世界上最好的AED中。双相波形通过两个独立的矢量进行电击，降低了除颤阈值，改善了病人的治疗效果。
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将他们的理论付诸实践，完成了对哺乳动物--特别是狗--的首次闭合式胸部除颤术。换句话说，他们能够通过在胸部表面施加电极来使动物苏醒，而不需要打开胸腔直接接触心脏器官。这是一个巨大的进步。
The First Defibrillation in Humans – 1947-1950
人类首次除颤 - 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以首次对哺乳动物进行闭胸除颤吸引了全世界的注意力后不到一年，一位名叫Claude Beck的美国心脏外科医生将证明为人类除颤的可行性。
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.
对Beck来说，这个任务是个人的。自20世纪20年代末以来，他一直大力投入颤动研究，当时他因心室颤动失去了一名病人。在整个20世纪30年代和40年代，他研究并试验了改善心脏循环和用手动心脏按摩治疗颤动的方法。
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等同事在西区（现在的凯斯西区大学）的成功动物实验后，他对电除颤产生了兴趣。他相信这种实验可以在人类身上复制并完善，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和俄亥俄州克利夫兰大学医院的一组调查人员完成了对一个人的首次开胸除颤手术。患者Richard Heyard是一个14岁的男孩，正在接受先天性胸部缺陷的治疗。他的心脏在手术接近尾声时进入室颤，而手动按摩并不能阻止这一问题。在没有其他选择的情况下，Beck将两个电极连接到Heyard的开放心脏上，并以110伏的电压电击了四次。心律得到了恢复，Heyard完全康复了。
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.
这个故事成为全球新闻头条。其中一个标题是："科学如何让美国人起死回生"。从那时起，Beck致力于改进用于人类的电除颤技术。他开发了最初的除颤器原型，虽然在当时具有纪念意义，但它只不过是一个大木箱，上面有两个金属电极。
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和他的同事最终发展了一些至今仍在使用的心肺复苏术。他们对3000多名医生和护士进行了心肺复苏术培训，并最终为非专业人士开发了心肺复苏术课程。他的工作代表了AED历史上的一个转折点。
The First Portable External Defibrillators – 1950-1956
第一台便携式体外除颤器--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.
当Beck和他的同事们致力于改善医院的除颤工作时，另一位医生 William Kouwenhoven正致力于开发一种更便携的解决方案。Kouwenhoven是约翰霍普金斯大学工程学院的院长，他因在狗身上成功进行开颅除颤实验而闻名。在20世纪50年代初，他开始试验直流电驱动的便携式除颤器设计。但在当时，没有足够强大的直流电池来产生闭合心脏除颤的必要电荷。
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开始探索用交流电代替，他终于走上了开发可持续便携式除颤器的道路。到1957年，他完成了供人使用的原始闭合式胸部除颤器之一的工作。该设备使用交流电向成人心脏安全地提供480伏的电击。唯一的问题是它的重量超过250磅（120公斤），这使得它作为一个便携式设备完全不实用。尽管如此，Kouwenhoven和他的团队仍然不断创新，到1961年，他们开发了第一个真正的便携式除颤器。它重约45磅，能够装入一个小手提箱。
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.
尽管Kouwenhoven的贡献是不朽的，但他的遗产最终会被与他同时代的Paul Zoll所代替，后者也在研究便携式除颤仪。今天被公认为现代心脏治疗之父的Zoll在1947年开始对治疗心室颤动感兴趣。与他之前的Beck一样，他的兴趣是在他因心脏骤停而失去一个病人之后被点燃的。
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.
他的激进思想--如他倾向于闭胸抢救而不是开胸抢救，以及他使用直流电击来刺激心脏活动--在20世纪50年代遭到了抵制甚至嘲笑，但这些技术最终成为甚至今天使用的体外除颤做法的标志。
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使用体外除颤器抢救了两名心脏骤停患者。虽然第一个病人只活了20分钟，但第二个病人在被救活后活了近一年。Zoll继续发展他的技术，到1956年，他开发了一种新的闭合胸腔的方法，用更大的冲击力安全地给病人除颤，冲击力高达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在几个月内相继开发了他们的胸腔闭合设备，虽然两位医生都改变了心脏治疗的面貌，但Zoll曾经有争议的技术经受住了时间的考验，影响了几代心脏研究人员。1980年，Zoll与他人共同创办了ZOLL医疗公司，而ZOLL自动体外除颤器直到今天仍在不断提高标准。
The First Portable Defibrillators in the Field – 1965-1969
第一批现场便携式除颤器 - 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.
尽管 Zoll和Kouwenhoven在20世纪50年代进行了便携式除颤的实验，但直到60年代中期，世界上才会看到这种设备出现在现场。1965年，爱尔兰医生和心脏病专家Frank Pantridge开发了一个150磅重的便携式除颤器，用于Belfast的救护车。它由汽车电池供电。
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开发了一种改进的便携式除颤器，它的重量不到7磅，由美国宇航局设计的微型电容器供电。这种小而轻的设备由于其尺寸和功率，通常被认为是第一个真正的便携式自动除颤器。
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世纪60年代末开始，Pantridge的创新设计就被世界各地的医院和救护车所采用。然而，令人惊讶的是，这项技术在成为他自己国家的主流之前，就已经在国际上火了。除颤器直到1990年才成为英国所有救护车的标准配置。
The Modern History of AEDs – 1978 to the Present
AED的现代史--1978年到现在
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.
即使便携式除颤器在20世纪60年代成为现实，但这种设备要在数年后才会向普通公众开放。对于将能够向心脏发出数百伏电击的设备委托给未经训练的普通人，人们的担心是可以理解的。
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，俄勒冈州波特兰市的一群同事提出了解决方案。医生Arch Diack和W. Stanley Welborn与工程师Robert Rullman合作，目的是开发一种万无一失的便携式除颤器，让旁观者在紧急情况下可以安全使用。
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，他们开发了Heart-Aid，这是第一个为训练有素的非专业人员设计的商业化AED。该设备包含一个特别设计的传感器，操作者可以将其插入病人的气道。该传感器可以检测病人是否在呼吸（因此不是心脏骤停），然后停止操作。一个计算机芯片也可以从电极检测心率活动，并确定是否存在可冲击的心律。
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.
一个粘性电极垫使该设备对未受过训练的用户来说是安全的，因为它允许用户采取不动手的方式，避免因操作不当可能导致的那种意外电击。最后，该设备配备了实时语音辅导，因此未经训练的用户可以听从并提供紧急治疗。
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.
尽管Heart-Aid从未取得重大的商业成功，但它为现代自动体外除颤器奠定了基础。目前正在生产的每台自动体外除颤器都依赖于源于该设备的惯例，包括使用胶垫、心律评估和语音指导。
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.
自动除颤器的历史仍在展开。今天，大多数设备的重量在3磅左右--与William Kouwenhoven开发的250磅的 "便携式 "除颤器相差甚远。许多设备都能提供自动电击，而且大多数都可以在家里使用。它们维护成本低，易于操作，并随着新技术的出现不断改进。
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.
如果你需要使用这些设备，你可以感谢William Kouwenhoven、Claude Beck、Frank Pantridge和Paul Zoll等创新者的不懈研究和实验。
信息来源：CPR1 LLC.
AED急救；自动体外除颤器；心脏除颤；拯救生命；