[3][4] Historically, this has been accomplished through the electrical stimulation of a phrenic nerve by an implanted receiver/electrode,[5] though today an alternative option of attaching percutaneous wires to the diaphragm exists.

[6] The idea of stimulating the diaphragm through the phrenic nerve was first firmly postulated by German physician Christoph Wilhelm Hufeland, who in 1783 proposed that such a technique could be applied as a treatment for asphyxia.

[9] It was not until a year later that Hugo Wilhelm von Ziemssen demonstrated diaphragm pacing on a 27-year-old woman asphyxiated on charcoal fumes by rhythmically faradizing her phrenic nerves, saving her life.

[11] However, advances in mechanical ventilation by the likes of George Poe in the early twentieth century[12] ended up being initially favored over phrenic nerve stimulation.

[1] In a separate publication a few days before, the same group also revealed they had an opportunity to use the technique "on a five-year-old boy with complete respiratory paralysis following rupture of a cerebral aneurysm".

[15] The Avery Breathing Pacemaker received pre-market approval from the FDA in 1987 for "chronic ventilatory support because of upper motor neuron respiratory muscle paralysis" in patients of all ages.

[17] By the early 1990s, long-term evaluations of the technology were being published, with some researchers such as Bach and O'Connor stating that phrenic nerve pacing is a valid option "for the properly screened patient but that expense, failure rate, morbidity, and mortality remain excessive and that alternative methods of ventilatory support should be explored".

[28] Research into the efficacy of diaphragmatic pacing (DP) for ventilatory support has had mixed results, that depend largely on the disease process of the patient population being studied.

[31] According to a number of high profile studies, diaphragm pacing should not be used to treat respiratory failure in patients with Amyotrophic Lateral Sclerosis (ALS).

[33][34] Studies have demonstrated a significantly higher mortality rate in patients with activated DP implants, than those who received the traditional MV for treatment in later stages of ALS.