Automatic external defibrillator

(AED)
What Is an Automated External Defibrillator?

 An automated external defibrillator (AED) is a lightweight, portable

device that delivers an electric shock through the chest to the heart.
 The shock can potentially stop an irregular heart beat (arrhythmia) and
allow a normal rhythm to resume following sudden cardiac arrest (SCA).
 SCA occurs when the heart malfunctions and stops beating unexpectedly.
If not treated within minutes, it quickly leads to death.
 System Theory
 Defibrillation consists of delivering a
therapeutic dose of electrical energy to the
affected heart . This depolarizes a critical
mass of the heart muscle, terminates the
dysrhythmia, and allows normal sinus
rhythm to be reestablished by the body’s
natural pacemaker in the Sino atrial node of
the heart.
 Automatic refers to the unit’s ability to
autonomously analyze the patient’s
condition; to assist this, the vast majority of
units have spoken prompts, while some may
also have visual displays to instruct the user.
 With simple audio and visual commands,
AEDs are designed to be simple to use for the
nonmedical persons
 AED is portable equipment and thus may run on
rechargeable battery.
Typical Architecture
 The energy selection is decided by the AED device automatically
according to the electrocardiogram (ECG) and impedance gotten
from both of the defibrillator electrodes,
 Then the safety processor controls the power circuit to charge the
high voltage capacitor with selected energy.
 After the capacitor charging is complete, the device should
prompt the user to do a shock operation, which is a high risk
operation, and a double confirmation is always needed to make
sure both the operator and the patient are safe.
 Before and after defibrillation, the optional multi-lead ECG
monitor (3/5/10 leads) may be used to evaluate the treatment.
 The ECG in the defibrillator electrode is a simple single-lead ECG
for basic ECG measurement like R wave recognition.
 The negative potential of the capacitor gets to the sternum and
the positive potential to the apex paddle.
 Adhesive electrodes are disposable items and can not be reused.
They also have an expiration date because the adhesive also acts
as a conductive gel and it looses its properties overtime. As a
result serious burns may occur.
Block diagram
Circuit description – main components
 The basic circuit of an AED consists of a high
voltage power supply, a large capacitor as an
energy storage, a relay for switching over from
charge to discharge, a control unit, an ECG and
the two paddles.
 A high voltage power supply HVPS starts to
charge up the high voltage capacitor (typically
15 μF - 40 μF) when the push button is pushed.

 The charge voltage depends on the body

resistance calculated by the microprocessor.
Usually energies between (2 J) and ( 200 J) can
be set. This corresponds with a charge voltage of
between (300 V) and (3400 V).

 The coil (typically 50 mH) is used to create a

better physiologically waveform and to prolong
the duration of current flow (3 - 10 ms)
 When the capacitor is fully charged an audio
signal will guide user to press discharge button.
Circuit description – power supply
 The power supply in a defibrillator is a
combination of two step-down power
supplies, and one step-up power supply .They
all work as switch mode power supplies
(SMPS). One delivers all needed low voltages
for the control electronics, one delivers the
high voltage DC for charging the capacitor ,
and one charges the internal battery.
 The voltage can reach approximately 5000V.
Such a high voltage needs extraordinary
safety measures and an excellent design.
 Also all components around the capacitor
have to be heavy duty components ,which
are able to withstand these high voltages and
high currents.
 Blank connections are sealed with plastic
or silicon. This also applies to the PCB. The
tracks have to be protected against contact
and flashovers.
Circuit description - High voltage charger
The idea is to use a transforming circuit boosting the battery voltage to
a defined voltage level which is then stored in a high voltage capacitor.
The capacitor, which acts like a fuel tank during the defibrillation
sequence, has a stored energy level which can be calculated using the
formula:

Care has to be taken that the components

of the charging and discharging circuits can
cope with such high voltage levels.
# High isolation step up fly back transformer.
# high voltage rectifier.
# high voltage capacitor.
# silicon insulated connection wires.
# Wide spacing between PCB tracks .
Circuit description – energy monitor
 There is a circuit that monitors the
charge process and blocks the discharge
switch when the capacitor is not fully
charged.
 The defibrillator can measure the real
energy which is given to the patient. The
shock voltage (at the capacitor) is
monitored by a voltage divider , and the
patient current during the shock is
measured with a secondary coil .
 Both measurements get to a
microcontroller in the control unit.
Together with the shock time the
microcontroller calculates the energy
and switches off discharge circuit when
the preset energy amount is delivered.
 Energy(joules)=voltage*current*time
Circuit description - Over voltage shutdown
This is implemented in order to protect
the user and electronics if the voltage on
the capacitor becomes too high.
The voltage on the capacitor could keep
rising if, for instance, the processor hangs up
and does not stop the charge signal or if the
voltage measurement circuit is faulty.
This means that the voltage protection
circuit needs to be made completely in
hardware.
If this voltage VRs is higher than the zener
voltage, Vz, the diode conduct in its reverse
direction, allowing a current to create a
voltage across the resistor Rv.
This voltage is the same as the driving
voltage of the thyristor(TH) which will cause
this to conduct and discharging the capacitor
Cmain via Rd.
Circuit description - Automatic internal discharge

 For safety reasons the automatic

discharge is needed to avoid the main
capacitor being left at high voltages
when not operated. For instance, if the
capacitor is charged and the medical
personnel finds it unnecessary to
complete the defibrillation, the
capacitor should be discharged without
connecting the load (the patient).
 This protection is most easily achieved
by letting the safety processor monitor
the time passed since the charging
stopped. When the maximum idle time
is achieved, the safety processor
produces a control signal that is used to
drive a transistor to discharge the main
capacitor into internal power resistor.
Modified Automatic internal discharge

 Since the previous circuit disrupts the whole

idea of electric isolation between high voltage
and control electronics, the control signal
needs to be transferred to the high voltage
side without electrical connections., this can
be done either by an optocoupler or a
transformer.
 The first alternative, the optocoupler, transfers
DC signals in a straight forward manner, but it
requires power supply on the secondary side. This
makes it complicated to use since the voltage level
on the secondary side is varying.
 The latter alternative, the transformer, can not
transfer DC signals but does not require any power
supply on the secondary side. The problem with
DC signals can be solved by modulating the
control signal with a high frequency signal
(carrier). This is achieved by using a fast AND gate
with the control signal and the high frequency
signal as inputs,
 Circuit description - Output discharge circuit
The four quadrant converter (sometimes
called H-bridge), is the main building block
of the discharge module.
The converter allows the current to flow in
both directions through the load depending
on which transistors that are conducting.
This means that the transistors should
conduct according to the following list:
1. T1 and T3 are on
2. All transistors off
3. T2 and T4 are on
4. All transistors off
One important detail regarding the converter is
that the emitter potentials of T1 and T2 are
dependent on the switch states of the
transistors. This implies that the power supplies
for the driver circuits of both transistors T1 and
T2 must be galvanically separated from the one
used for driving T3 and T4.
Circuit description - Current measurement circuit

 In order for any current control to work

properly the current through the load needs
to be measured. Measuring the voltage drop
across a series resistor would not be a good
solution since the resistor would dissipate
energy and the need for an extremely fast and
accurate optocoupler would introduce much
uncertainty in the measurement. Instead, a
LEM module is used.
 The LEM module consist of a ferrite core coil
with a Hall element, measuring the magnetic
flux of the core, producing a voltage on the
secondary side corresponding (linearly) to the
current through the coil.
battery
 The biggest problem with defibrillators is the
internal battery. These rechargeable batteries have
to be always charged even if the defibrillator is not
used. If this does not happen the battery loses its
charge due to self-discharge and once dropping
under the discharge cut-off voltage the battery gets
damaged.
 NiCd batteries are sensitive to partially discharges and
incomplete and irregular charging. They need regular
discharging and charging, otherwise they rapidly loose
capacity (memory effect). Because of these drawbacks
NiCd batteries are not suitable any more for medical
equipment these days and should always be replaced with
nickel metal hydride (NiMH) batteries.
 The manufacturers suggest replacement every two years.
Therefore batteries of defibrillators have a label which
shows the date of last exchange.
 In general, batteries should be replaced only with
the same type and size (Ah). If this is not possible or
not wanted (in case of NiCd batteries) make sure
that the end-of-charge voltage of the battery is
similar. If the battery voltages (nominal and end-of-
charge voltage) are different the new battery would
not get fully charged or gets overcharged.
AED Design Considerations
Safety is the first priority in AED design. Any
operation must ensure the safety of both operator
and patient, so some redundant designs are
necessary.
 Both the safety and the operation processor need to
check each other to ensure the right decision.
 Discharge the charged capacitor if it times out.
 Double confirmation is required for energy delivery.
 An audio prompt can be used to indicate how to do the
next step.
 Disable the energy delivery if the target impedance is
not in range of the human body.
 The device must ensure enough insulation between the
internal high voltage and the device surface/port.
 The device must provide an insulation mechanism
between the internal high voltage and low voltage part.
AED Design Considerations - continued
 Fast boot-up for operation.
 Fast response to an external signal like the external patient monitor
trigger out.
 Real-time R wavelet recognition for exact time to delivery energy.
 Real-time energy control for the shock procedure.
 Fast charge and energy delivery to save time.
 Wide operation temperature range.
 Lower performance drift over temperature range, like bias current and
noise.
 The power circuit should work well for large current surges.
 An audio recorder can be used to record the rescue procedure for
evidence.
 Wireless connectivity like Wi-Fi is helpful for the device in the hospital;
GPRS/3G is helpful for the device out of the hospital.
 Some peripherals like LAN and a memory card are used for the electrical
medical system.
 RESOURCES

 https://www.redcross.org/take-a-class/aed/using-an-aed/what-
is-aed
 https://www.fda.gov/medical-devices/cardiovascular-
devices/automated-external-defibrillators-aeds
 https://www.sciencedirect.com/topics/medicine-and-
dentistry/defibrillator
 https://www.weinmann-
emergency.com/products/defibrillators/
 https://www.bhf.org.uk/how-you-can-help/how-to-save-a-
life/defibrillators

Prepared by Eng. Mohamed Elghedany