Defibrillation

Excerpt

Heart disease remains the leading cause of death for both sexes in the United States, with 702,880 fatalities recorded in 2022, according to the Centers for Disease Control and Prevention. Nearly half of these deaths occur outside of a hospital, with three-quarters taking place in the home and half of those being unwitnessed. Among adult patients, ventricular fibrillation (VF) is the most common cause of sudden cardiac arrest.

Cardiac defibrillation is the process of delivering a transthoracic electrical current to a patient experiencing one of 2 life-threatening ventricular dysrhythmias: VF or pulseless ventricular tachycardia (VT). Both conditions are treated identically under Advanced Cardiac Life Support (ACLS) guidelines. The definitive treatment for VF is electrical defibrillation, which is most effective when performed immediately after VF onset. The success rate of defibrillation declines by nearly 10% for each minute of delay.

The first recorded case of open-chest defibrillation in a human was performed in 1947 by American cardiac surgeon Claude Beck on a 14-year-old patient undergoing surgery for a congenital chest defect. In 1957, William Kouwenhoven developed the first external defibrillator, weighing over 250 pounds (120 kg). By 1961, advancements led to a portable defibrillator weighing approximately 45 pounds. Survival rates for adult patients who experience nontraumatic cardiac arrest and receive emergency medical services resuscitation are low, with only 10.8% surviving to be discharged from the hospital. In contrast, in-hospital cardiac arrest patients have a survival rate of up to 25.5%, largely due to defibrillation being performed closer to the onset of VF. According to the American Heart Association, approximately 350,000 people experience out-of-hospital cardiac arrest annually.