[New aspects of electric defibrillation]

Early defibrillation is the standard of care for patients with ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT). Technical developments aim at further miniaturization and simplification of defibrillators as well as adaptation of energy requirements to the patient's needs. Implantable Cardioverter-Defibrillators (ICD) and automated external defibrillators (AED) are based upon the same technology. Both devices analyze the ECG signal internally, followed by a "shock" or "no shock" decision. Use of automated devices is the prerequisite for defibrillation by non-physicians. Chest impedance measurements and use of alternative shock waveforms, such as biphasic, aim at adaptation of energy or current to the patient's individual needs and avoid application of unnecessarily high amounts of energy to the myocardium. Calculation of median frequency is a non-invasive method for analyzing the heart's metabolic and electrical state. It helps to determine the optimal moment for defibrillation during cardiopulmonary resuscitation (CPR). Developments concerning the structure of in-hospital emergency systems or pre-hospital emergency medical services (EMS) aim at further reductions in time from collapse of a patient until first defibrillation. Such developments include early defibrillation programs for emergency medical technicians (EMT), nurses, and fire or police department first responders as well as wide distribution of easy-to-operate defibrillators in public areas, as discussed during the American Heart Association's Public Access Defibrillation conferences. All programs of that kind have to be organized and supervised by a physician who is responsible for training and supervision of the personnel involved.