Innovation Timeline
HeartSine: A lifesaving legacy in mobile defibrillation technology
1966 1969 1971 1973 1970s 1980s 1990s 2000s
Contributions to sudden cardiac arrest (SCA) intervention technology have been both extensive and consistent. In fact, every AED in use today can trace its roots to technology envisioned and initially developed by HeartSine® technologists in an uninterrupted march toward better and miniaturized defibrillators. It’s a record of innovation unmatched in our industry.
Sudden death from heart disease is a true challenge to health care. The importance of immediate care to treat sudden cardiac arrest has been well established over the past four decades. HeartSine helped form that part of history.
A study by McNeilly & Pemberton (under the direction of Professor Frank Pantridge, Royal Victoria Hospital, Belfast) demonstrated that a majority of heart attack deaths occurred soon after the onset of symptoms. Professor Pantridge (1916-2004) was the first to forward and implement the idea of mobile coronary care. As a result, he is known as “The Father of Emergency Medicine.”
Professor John Anderson (M.Phil., Ph.D. Medical Engineering), was for many years a key member of the Board of Directors at HeartSine and our Chief Technical Officer. In the 1960s, he was approached to start the BioMedical engineering group at the Royal Victoria Hospital and headed the effort to produce the world’s first mobile defibrillator to address this need. In essence, the need was to bring the expertise of the hospital to the patient to improve outcomes. The result changed the way emergency care is delivered globally, a legacy which endures to this day.
1966
The first mobile defibrillator unit was introduced in Belfast, under the medical direction of Dr. Pantridge and Dr. Geddes at the Royal Victoria Hospital in Belfast in 1966. A mains (AC) powered defibrillator was powered by an inverter, which converted a 12V car battery to 230 volts. The system weighed 110 lbs., which made it difficult to move and cumbersome to operate. However, significant improvements to outcomes of sudden cardiac arrest patients were soon observed.
The world’s first Mobile Coronary Care unit was born. Management of heart attacks outside the hospital was now possible. It soon became obvious, however, that lightweight, battery-operated defibrillators were urgently required if mobile coronary care was to become more widespread.
1969
Lighter weight defibrillators were developed in Belfast in 1969 with John Anderson’s team, now expert in mobile defibrillation technology. Early developments included new capacitor materials and circuit miniaturization.
The American Optical Company produced the first entirely portable DC defibrillator incorporating these advancements, with a reduced weight of 44 lbs. – under half the weight of the earlier inverter units!
1971
With material advances to reduce weight, other technologies were being incorporated to deliver efficacious shock therapy at reduced energies. This served to further reduce weight without compromising effectiveness. Professor Anderson et. al. developed a new waveform introduced with the PANTRIDGE PORTABLE 15 defibrillator – a unit which weighed only 15 lbs. This device was manufactured for Belfast by the Coleraine Instrument Company, and featured rechargeable ni-cad batteries, which could deliver upwards of 70 shocks. This reliable instrument became the standard of care for mobile units until 1974.
1973
John Anderson’s team now addressed a new challenge – to provide mobile continuous ECG monitoring until patient arrival at hospital, and to provide an event record for review.
The system, known as CORA (Combined Oscilloscope & Recording Apparatus) was the first mobile system also to incorporate a speech channel track for rescuers to record comments, drug information, patient information, etc.
A new “fast-scan” system was also incorporated enabling a 2-hour patient record to be scanned in 5 minutes. The 3 main advantages: lightweight, continuous recording and reusable tapes.
The above picture shows the new Pantridge PP15 Defibrillator in the black case, along with the new CORA unit developed for the mobile coronary care unit
Mid 1970s
The Belfast team, under Professor Anderson’s direction, were then in the forefront of mobile defibrillator technology development. Their patented portable defibrillator – the Pantridge 280 – was significant in that these new devices were a fraction of the size and weight of the first mobile unit used.
Professor Anderson is shown here with one of the early lightweight systems developed in Belfast, and subsequently manufactured for them by Cardiac Recorders of London. The unit was designed to specifications developed and prototyped at the Royal Victoria Hospital in Belfast. This unit weighed only 7.5 lbs, and became the first truly lightweight portable defibrillator for emergency services. Six hundred units were sold in the United States alone.
The Pantridge Model PP6
New capacitors and new operational capabilities enabled this unit to be reduced in size and to a new weight of only 6.5 lbs. Professor Anderson’s group had succeeded in providing the standard for future mobile platforms.
The above version – the Pantridge PP6 was released with one of the first optional printers incorporated into the unit. This unit eventually was manufactured by Temtech as the Liteguard 6. The Marquette company later purchased Temtech, and continued to successfully manufacture defibrillators, such as the one below.
1980s
The concept of telephone-controlled defibrillation was suggested in the early 1980s (Buessman, 1982). The technology was progressing towards having systems available for automatic external use in public areas, and this device enabled users to connect patients to electrodes that were monitored by clinical experts at a base station through a regular telephone line. The patient unit automatically dialed the base station, and retrieved any patient medical records that could be available. ECG could thus be monitored remotely. This leading-edge device could then send a control signal back over the telephone to defibrillate the patient! The rescuer could therefore use this device remotely with minimal training, having the support of a skilled operator controlling therapy.
Above: Remote Use Defibrillator and Defibrillator Base Station
The Belfast Experience
The Belfast experience, as it came to be known, became an emergency care model that was quickly adopted throughout the western world. Mobile coronary units were modeled on the Belfast plan, and first adapted for use throughout the United States, Britain, Switzerland, Norway, Holland, Australia, Japan, and Brazil. According to Richard Crampton (MD, FACP, FACC, Prof. of Medicine, U. of VA), the introduction of the mini-defibrillator has been one of the most important contributions, (“The Acute Coronary Attack,” J.Pantridge, J. Adgey, J. Geddes, S.Webb, foreword, 1975).
Professor Anderson and his group spearheaded design advancements that are used in current defibrillator models worldwide. A host of patents followed. Some of the “firsts” that came out of the Belfast group include:
- First mobile defibrillator
- First use of Mylar capacitors for efficiency and weight reduction
- Development of the first miniaturized capacitor, through a cooperative project with CSI, CA (later used in the Life Pack 5 defibrillator by Physio Control)
- First truly portable defibrillator provided in a transport case
- One of the first rechargeable systems with integrated printer capability
- First defibrillator that could operate over a telephone system to a base station
- Patent in 1980 for waveform algorithm with a defibrillator shock decision tree, elements of which are still in use in external and internal defibrillator algorithms
- Development for the first flat screen displays
- Early version tape recorder incorporated into systems for speech recording
- First IP56 (ingress test certification) and 7-year warranty in one unit
- Patented Pad-Pak™ technology, combining electrodes & lithium-ion manganese battery in one disposable unit for simplicity of use and ease of maintenance
1990s
HeartSine Technologies Formed
John Anderson founded HeartSine in 1998 in conjunction with a group of investors to further the development of portable defibrillators based on his early Belfast experience. While lightweight defibrillators were providing the type of instruments required by medical personnel, there was a clear need to develop defibrillators which could save lives by non-professional users with minimal training.
The first HeartSine defibrillator was the AED – The Automated External Defibrillator.
The AED was introduced with LCD screen for ECG trace and graphic (with written) instructions. Audible prompts also helped coach users in proper operation of the unit. A professional model (SAM-001) was introduced, with manual shock override control, and ECG screen. A step-down unit was soon released removing manual override (SAM 002) and a third variant (SAM 003) followed with only Icon display (no ECG) and no manual override. This was HeartSine’s first direct foray into addressing the growing need for easy-to-use products for public access defibrillation. Since professional responders were experiencing improvements in outcomes, a natural progression would be to make these instruments easier to operate for laypersons with only basic training. Today, these units are becoming commonplace in shopping centers, airports, gyms and health clubs, schools, and many other public access areas.
2000 to Present
HeartSine samaritan® PAD
The HeartSine samaritan PAD, or Public Access Defibrillator, was introduced in 2004. The latest in the evolution of portable defibrillation, the PAD unit has been improved in function and reduced in weight to a device weighing less than 2 lbs. (with battery, 2.4 lbs.). The PAD unit utilizes sophisticated algorithms designed to automatically sense patient heart rhythms and to apply a shock only when necessary. It also prompts users in the rescue process – both audibly and visually. The HeartSine samaritan PAD also improves ergonomics, with only 2 buttons – On/Off & Shock, and with 3 icons which illuminate to provide visual instruction. The device also utilizes a revolutionary concept in design whereby the battery and electrode pads are contained in a single cartridge or Pad-Pak, with only 1 expiry date for users to monitor. Recognizing the importance of CPR with AED use, the samaritan PAD also provides rate coaching for chest compressions – both audibly and visually for support in loud environments.
samaritan PAD with CPR Advisor (currently not available in the U.S.)
Recognizing the importance of CPR with AED use, the samaritan PAD also provides rate coaching for chest compressions. Additionally, HeartSine has developed a unique method for accessing CPR performance. The HeartSine samaritan PAD with CPR advisor — 500P — uses an Impedance Cardiogram (ICG) to determine if CPR is being applied hard enough and at the correct rate.
New research is ongoing for product improvements, with the goal of providing new and innovative technologies for next-generation lifesaving devices accessible to everyone.