# Ohio medics to try out new Swedish CPR device



## MMiz (Dec 30, 2008)

*Ohio medics to try out new Swedish CPR device*

COLUMBUS, Ohio — Columbus medics are once again testing a CPR machine in hopes that it can outdo their manual efforts to restart hearts.

For two months, medics from stations 6 and 24 in Columbus will use a device called the Lucas CPR chest-compression system. The Swedish product is sold by a division of Medtronic and costs about $14,500 per machine.

*Read more!*


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## DR_KSIDE (Jan 4, 2009)

I have seen that machine used and it always reminded me of the video of the CPR Jackhammer. Zoll makes one, I think it is called the Autopulse, that, in my opinion, looks easier to use.


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## Ridryder911 (Jan 4, 2009)

It will be interesting to see how many litigation's will be filled. As in substitute blood that the patients were not officially informed of risks and alternative routes, permission, etc. 

R/r 911


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## Sparky79 (Jan 4, 2009)

Ridryder911 said:


> It will be interesting to see how many litigation's will be filled. As in substitute blood that the patients were not officially informed of risks and alternative routes, permission, etc.
> 
> R/r 911



That was the first thing that popped into my head as well.

I don't understand how they could be "testing" an unproven product without fully informing their test subjects and having signed release forms. (obviously not possible with a patient who needs CPR:unsure


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## BEorP (Jan 4, 2009)

Sparky79 said:


> That was the first thing that popped into my head as well.
> 
> I don't understand how they could be "testing" an unproven product without fully informing their test subjects and having signed release forms. (obviously not possible with a patient who needs CPR:unsure



How could any unproved product be validated for patients in cardiac arrest without waiver of consent trials? The trial will surely be approved by an IRB and not enroll more patients than are needed to demonstrate a difference in outcomes.


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## flhtci01 (Jan 4, 2009)

Sparky79 said:


> That was the first thing that popped into my head as well.
> 
> I don't understand how they could be "testing" an unproven product without fully informing their test subjects and having signed release forms. (obviously not possible with a patient who needs CPR:unsure




I don't remember the exact details as this was from a couple of years ago but basically the testing can take place in an emergency situation when there is not enough time to get an informed consent after the public has been informed.

Iowa Resuscitation Outcomes Consortium addressed this issue by having informational presentations in the regions of testing.  People could "opt out" of being a test subject by wearing a special bracelet.


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## NolaRabbit (Jan 5, 2009)

My service field-tested the Lucas for a few months and our reviews pretty  positive. I think it was a bit too cost-prohibitive in the end, though.


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## Flight-LP (Jan 5, 2009)

Sparky79 said:


> That was the first thing that popped into my head as well.
> 
> I don't understand how they could be "testing" an unproven product without fully informing their test subjects and having signed release forms. (obviously not possible with a patient who needs CPR:unsure



http://www.emtlife.com/showthread.php?t=10456

They are not "testing" anything. Trials have already taken place and it is approved for us in the U.S. (marketed and sold by Physio-Control)

Prior to that, it has been used in Europe for several years with great results. Considering this device effectively takes the mechanical strain out of CPR and thus eliminating ineffective compressions (i.e. one of your leading factors for inability to obtain ROSC), you may not want to dismiss it so quickly.

The above thread has some pro's and con's to the Zoll Autopulse that you may be interested in.


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## BEorP (Jan 5, 2009)

Flight-LP said:


> http://www.emtlife.com/showthread.php?t=10456
> 
> They are not "testing" anything. Trials have already taken place and it is approved for us in the U.S. (marketed and sold by Physio-Control)
> 
> ...



The fact remains though that mechanical CPR devices have not been proven to improve outcomes.


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## traumateam1 (Jan 5, 2009)

BEorP said:


> The fact remains though that mechanical CPR devices have not been proven to improve outcomes.



But it frees up a medic to do other things right? Meds, manual defib, tube the patient, and all that fun stuff.


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## Flight-LP (Jan 6, 2009)

BEorP said:


> The fact remains though that mechanical CPR devices have not been proven to improve outcomes.




The only that has been proven to improve outcomes is God's good humor. 

Regardless of how good we get in the field, in the hospital, in the OR, or anywhere else, there are individual physiological factors that no one will ever be able to change. However, this device, along with other interventional tools such as the ITD, sound communication among code team members, early intervention with ALS capabilities, and better access to care, has been shown to increase the possibility of ROSC. That has been proven time and time again. ROSC is the only tangible definition of success that we remotely can control pre-hospital. End outcome involving neuroligical deficits is beyond our capabilities. We can aid in the reduction of neuro deficits, but only time and devine intervention currently dictate the final outcome...................


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## marineman (Jan 6, 2009)

BEorP said:


> The fact remains though that mechanical CPR devices have not been proven to improve outcomes.



That's why several companies are spending millions of dollars to do research to either prove or disprove that point.

My area is a part of the Autopulse study. When we learned about the procedure for the study there is some sort of law for this type of study where informed consent is obviously impossible that allows us to carry on with the study as long as it's for research. Again not sure how they worded it and I'm probably leaving parts out but that's the basics of it.


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## downunderwunda (Jan 6, 2009)

Mechanical CPR devices do provide better outcomes. Studies show that a person can perform 'effective' CPR for about 1 minute, then it diminishes.

Isnt this a good thing?


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## BEorP (Jan 6, 2009)

Flight-LP said:


> The only that has been proven to improve outcomes is God's good humor.
> 
> Regardless of how good we get in the field, in the hospital, in the OR, or anywhere else, there are individual physiological factors that no one will ever be able to change. However, this device, along with other interventional tools such as the ITD, sound communication among code team members, early intervention with ALS capabilities, and better access to care, has been shown to increase the possibility of ROSC. That has been proven time and time again. *ROSC is the only tangible definition of success that we remotely can control pre-hospital. End outcome involving neuroligical deficits is beyond our capabilities. We can aid in the reduction of neuro deficits, but only time and devine intervention currently dictate the final outcome...................*



I don't understand why you don't think that prehospital treatment can change the final outcomes. ROSC doesn't matter. I don't care if my dad suffers a cardiac arrest and the paramedics get a ROSC if he does not have a good neuro outcome. Are you familiar with the ROC PRIMED study? They looking at survival to hospital discharge and neurological outcomes to validate the use of the ITD and to try to determine the optimal amount of up front CPR.


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## Grady_emt (Jan 6, 2009)

traumateam1 said:


> But it frees up a _medic _to do other things right? Meds, manual defib, tube the patient, and all that fun stuff.




I don't remember the last time I saw a medic do CPR, is'nt that what EMTs and Fire are for???h34r:


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## BEorP (Jan 6, 2009)

downunderwunda said:


> Mechanical CPR devices do provide better outcomes.


Show me the study that proved this.


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## BEorP (Jan 6, 2009)

traumateam1 said:


> But it frees up a medic to do other things right? Meds, manual defib, tube the patient, and all that fun stuff.



Sure, and more importantly if you are transporting a patient in cardiac arrest it means that no one needs to be standing up in the back doing CPR. But then we should really be raising the question of why we are transporting cardiac arrest patients...


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## imurphy (Jan 7, 2009)

I was trained on the LUCAS in Ambex05. I like the machine, and the idea. Some of the stats I read on it at the time are very positive


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## firemedic1563 (Nov 17, 2009)

BEorP said:


> Show me the study that proved this.




Sorry to bring the horse back, but was seeing who else uses these and had to respond:

Olson Neurologic outcome study

LUND University study

Durnez In Hospital outcomes

There are a few more. And yes, this device is approved for use in the US by the FDA with 510K clearance, so consent is not needed.


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## Michael Sykes (Nov 20, 2009)

BEorP said:


> Sure, and more importantly if you are transporting a patient in cardiac arrest it means that no one needs to be standing up in the back doing CPR. But then we should really be raising the question of why we are transporting cardiac arrest patients...



I was taught, as a First Responder, that they aren't dead until they're cold and dead, or when rigor starts. There's always that slim chance of survival; otherwise, we might as well throw our AED's in the dumpster. Now, obviously, if we arrive on the scene of an arrest, and the person's as stiff as our backboard, we're better off calling for the coroner.


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## JPINFV (Nov 20, 2009)

Michael Sykes said:


> I was taught, as a First Responder, that they aren't dead until they're cold and dead, or when rigor starts.



Someone lied to you.


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## Michael Sykes (Nov 21, 2009)

JPINFV said:


> Someone lied to you.




What would you consider to be a unworkable victim of an unwitnessed arrest? At what point do we give up?


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## wyoskibum (Nov 21, 2009)

The last Swedish device I bought didn't work out too well.  But we won't go there!!! ;-D


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## JPINFV (Nov 21, 2009)

Michael Sykes said:


> What would you consider to be a unworkable victim of an unwitnessed arrest? At what point do we give up?



After several rounds of on scene ACLS medications with good CPR in a patient that is in a non-profusion, non-defibrallatable rhythm without special factors (such as hypothermia). Essentially, the same criteria that hospitals use to call codes.


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## kai.kasin (Dec 1, 2009)

wyoskibum said:


> The last Swedish device I bought didn't work out too well.  But we won't go there!!! ;-D



haha was it a Volvo?  cant probably even called it a device 

Lucas and Autopulse.. if it was such of genuis product and everything, why dont everybody have it?  because its more simple to use your hands? 
like everything in our work, keep it simple as possible


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## Sparky79 (Dec 1, 2009)

wyoskibum said:


> The last Swedish device I bought didn't work out too well.  But we won't go there!!! ;-D




Austin Powers didn't seem to have any complaints about his.


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## EricCSU (Jan 9, 2010)

Michael Sykes said:


> I was taught, as a First Responder, that they aren't dead until they're cold and dead, or when rigor starts. There's always that slim chance of survival; otherwise, we might as well throw our AED's in the dumpster. Now, obviously, if we arrive on the scene of an arrest, and the person's as stiff as our backboard, we're better off calling for the coroner.



Unfortunately, yes, you have been lied to.  There is a lot of research on the subject of out-of-hospital cardiac arrest.  If you don't currently have specific protocols on who should have resuscitative efforts and who does not, you really should.

The A/TCEMS protocol on Determination of Death (scroll down) is definitely cut and dry and backed by a ton of research on the subject.

We are also currently using the LUCAS device on a limited basis and it is definitely well-liked by providers.  A limited amount of AFD engines use the device as a trial currently, but I hope that the device is put on every engine.

Eric


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## LondonMedic (Jan 9, 2010)

BEorP said:


> Sure, and more importantly if you are transporting a patient in cardiac arrest it means that no one needs to be standing up in the back doing CPR. But then we should really be raising the question of why we are transporting cardiac arrest patients...


For PCI?


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## CAOX3 (Jan 9, 2010)

Michael Sykes said:


> What would you consider to be a unworkable victim of an unwitnessed arrest? At what point do we give up?



Someone with obvious signs of death.  In my area if you initiate CPR at the BLS level you continue it to the hospital.

If someone meets the criteria in which CPR is not initiated, we notify the medical examiner and wait for PD to release us.


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## Smash (Jan 11, 2010)

BEorP said:


> The fact remains though that mechanical CPR devices have not been proven to improve outcomes.



The fact also remains that epinepherine, vasopressin, amiodarone, atropine and intubation also have no proven benefits in improving outcome from cardiac arrest.  However, I don't see anyone complaining that we are using unproven treatments on patients when we push epi or any other drug into a dead person, despite the fact there is a degree of evidence that suggests that far from improving outcomes from arrest, epi might in fact cause worse outcomes.

What has been shown repeatedly is that good quality CPR is absolutely vital in achieving good outcomes, and that people can't do consistant, good quality CPR for long.  Further studies may be required into automated CPR devices, however there is a sound theoretical basis to start doing those studies.

I respectfully disagree that ROSC is the sole measure of success that we should be using.  International experience and studies have shown that a wide range of systems improvements and interventions such as therapeutic hypothermia can improve survival to discharge and neurological status at discharge and at 6 and 12 months, and this is the measure we should be looking at.  I can get a huge number of patients to hospital with a pulse, but that doesn't mean they'll ever leave hospital.


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## FLEMTP (Jan 12, 2010)

Michael Sykes said:


> What would you consider to be a unworkable victim of an unwitnessed arrest? At what point do we give up?



If i get there and it was an unwitnessed arrest, and the patient isnt warm, and they are in asystole, i dont work it. Also, we have the ability to stop CPR that bystanders or fire dept started. We pronounce them dead and call the Medical examiner ourselves. if the ME releases the body we also help the family contact a funeral home before leaving the scene.


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## Jeffrey_169 (Jan 12, 2010)

Maybe its just me but sometimes I wonder if we aren't getting too technical. The problem with machines is they fail, and typically when you need them the most. Ever got a flat tire when it was convenient? Was there ever a time when your car wouldn't start where thought "good thing I marked this in my day planner". I am all for neat gadgets, but sometimes we take it too far. We become too complacent and comfortable with the less reliable, and in the end no one is happy.

I am reminded of the women who was driving an RV who set her cruise control. While she was driving down the road she decided she wanted a sandwich and went back to the kitchen to make one. Needless to say she ran off the road and totaled the RV. She later sued and somehow won because the company never said you had to remain at the wheel. We have cars now which have apparently fixed even that little problem...now they brake for you, and even correct the steering. In my opinion this is only going to foster complacency and irresponsibility. 

I don't know, maybe I am wrong, just making an observation from history; or maybe I am just talking out of fear of change. I am curious to see the QA results.


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## Aidey (Jan 12, 2010)

Sure machines fail, but look at the statistics of how effective humans do CPR. We do not want to become too reliant on technology, but we also shouldn't discount it if it isn't perfect.


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## Jeffrey_169 (Jan 12, 2010)

I agree...I am just a skeptic is all. I am not closed to the idea, just a little doubtful is all.


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## Aidey (Jan 12, 2010)

Doubtful of what exactly? That it can do more effective compressions than a human or something else?


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## Jeffrey_169 (Jan 12, 2010)

Aidey said:


> Doubtful of what exactly? That it can do more effective compressions than a human or something else?



Doubtful of the practicality and effectiveness of such a device. I can teach a person how to be effective at CPR, and I can even correct at that moment, but if I am using, and placing faith, in a machine so I can do other things I am not paying attention to it, and so its a reliability issue as well. 

I am not saying its a bad idea, merely that its concerning. I think we need to be careful.


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## Smash (Jan 12, 2010)

Jeffrey_169 said:


> Maybe its just me but sometimes I wonder if we aren't getting too technical. The problem with machines is they fail, and typically when you need them the most. Ever got a flat tire when it was convenient? Was there ever a time when your car wouldn't start where thought "good thing I marked this in my day planner". I am all for neat gadgets, but sometimes we take it too far. We become too complacent and comfortable with the less reliable, and in the end no one is happy.



Comfortable with the less reliable...  The less reliable what?  Should we stop driving ambulances because they break down?  I've owned horses for years, they almost never break down.  A horse and buggy is far more reliable than my Ford, perhaps we should use them instead.  Less moving parts, less to go wrong I suppose.

What exactly is too technical about ensuring that CPR is performed to optimal levels 100% of the time?



> I am reminded of the women who was driving an RV who set her cruise control. While she was driving down the road she decided she wanted a sandwich and went back to the kitchen to make one. Needless to say she ran off the road and totaled the RV. She later sued and somehow won because the company never said you had to remain at the wheel. We have cars now which have apparently fixed even that little problem...now they brake for you, and even correct the steering. In my opinion this is only going to foster complacency and irresponsibility.



Sorry, what?  What on earth does an apocryphal anecdote regarding gross stupidity on behalf of a motorist have to do with automated CPR devices?



> I can teach a person how to be effective at CPR, and I can even correct at that moment, but if I am using, and placing faith, in a machine so I can do other things I am not paying attention to it, and so its a reliability issue as well.



What we can't do is overcome the simple fact that rescuers fatigue, ensuring that the effectiveness of CPR is decreased.  Not going to happen with an automated device.  If in the off chance the machine does fail, you go back to the old fashioned way of jumping up and down on chests.
If you can't keep an eye on an automated device during a resus, how on earth do you cope?  Surely you watch for rhythm changes, changes in EtCO2 that might signify ROSC, times for defib, times for drugs, doses for drugs and so on?  What about post-ROSC?  Multiple infusions, cooling, paralysis, 12 lead, haemodynamics, ventilation, oxygenation, notification to hospital... surely checking that a machine is going "thump thump thump" regularly is a fairly simple part of the whole system?


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## Jeffrey_169 (Jan 12, 2010)

We become so in tune with technology and when they fail we don't remember the skills. Technology is nice, but we need to remember the skills for when it fails.


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## reaper (Jan 12, 2010)

If a providers forget how to do compressions, then you have other problems. These devices are not new, they have been out for around 5 years now and have been shown to be effective and reliable. Most instances of failure are due to operator error. I would take one over 5 providers doing compressions. The machine is constant and does not fatigue or change rate.

Technology is designed to make things better. If you allow yourself to forget how to do things manually, then that is a problem you must fix. As long as we are still training people in the manual way of doing things, there is no problem.

GPS has been out for years. Most of us use them daily. We can still pick up a map and find our way around, if we need to. The problem you run into, is the newer people that are not trained on how to read a map book as a back up. This is the fault that we run into. Always train for worst case and hope for the best!

A lot of services now use epcr's. Does this mean that you stop showing new providers how to write a paper report? No. Because we all know that computers can go down at any time and you need a back up. This also does not mean that epcr's have not made advancement in reporting better. We are able to track statistics better and pull Pt's records faster.

Technology is here to stay. So, learn to embrace it and use it to it's benefit. But, always have a backup plan ready to go!


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## Jeffrey_169 (Jan 12, 2010)

reaper said:


> If a providers forget how to do compressions, then you have other problems. These devices are not new, they have been out for around 5 years now and have been shown to be effective and reliable. Most instances of failure are due to operator error. I would take one over 5 providers doing compressions. The machine is constant and does not fatigue or change rate.
> 
> Technology is designed to make things better. If you allow yourself to forget how to do things manually, then that is a problem you must fix. As long as we are still training people in the manual way of doing things, there is no problem.
> 
> ...



My point exactly.


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