External defibrillators and emergency external pacemakers

The first experimental defibrillation occurred in 1900. Zoll first achieved external defibrillation of a human heart in 1956 and the first commercial external manual defibrillators were introduced in 1961. We discuss the steady improvements in manual defibrillator performance which have occurred since 1961, particularly relating to added functionality, event documentation, and telecommunications, and speculate on likely trends in the next few years. We than consider the most important development of the last 30 years, i.e., the development and successful use of smart automatic or advisory external defibrillators (AED's) which are capable of accurately analyzing the ecg and of making reliable shock decisions. The first generation AED's were intended for use by paramedics or nurses. There is growing interest in developing very simple, reliable, and low cost AED's for widespread use by minimally trained first responders (e.g., fire fighters) and even lay persons (''public access defibrillation'') are discussed. Finally, we briefly discuss external pacemakers and self adhesive electrodes which have become common features of modern defibrillators.