# LUCAS 2 vs. Zoll Autopulse



## MMiz

I'm looking at both the LUCAS 2 and Zoll Autopulse, and they seem like similar products.  Can you provide details on what advantages the Lucas 2 has over the AutoPulse?


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## Physio Control

MMiz said:


> I'm looking at both the LUCAS 2 and Zoll Autopulse, and they seem like similar products.  Can you provide details on what advantages the Lucas 2 has over the AutoPulse?



Thanks for your question. We actually think the differences between the LUCAS 2 and AutoPulse are quite significant. Consider, for example, the following:


Size & weight: LUCAS 2 weighs 22 lbs. (in carry case w/ extra battery) compared to the AutoPulse @ 39 lbs. (in carry case w/ extra battery). 
Batteries: Each AutoPulse battery weighs 5.1 lbs., lasts for approx. 30 minutes, and requires a 10-20 hour reconditioning cycle with every 10th use. The LUCAS 2 battery weighs 1.3 lbs., runs for approx. 45 minutes, can recharge in under 4 hours, and there are AC or DC auxiliary power supplies available for longer resuscitations.
Total cost of ownership: Due to the high cost of the single-use, load distributing bands and the requirements for multiple spare batteries, the total cost of ownership for AutoPulse is approx. 25% higher over 5 years. 
Ease of use: The LUCAS 2 device can be applied in less than 20 seconds with minimal hands-off time. Defibrillator electrodes can be applied to patient after the LUCAS is deployed. 
Durability: LUCAS 2 has an IP rating of 43. AutoPulse has an IP rating of 24. 
Guidelines: The LUCAS 2 adheres closely to the AHA guidelines for Class IIa effective manual chest compression by providing continuous sternal compressions; at a rate of at least 100 compressions per minute; at a depth of at least 2”; and ensuring full recoil with a 50/50 duty cycle and a suction cup that assists the chest to the starting position.
Attached is a chart comparing the LUCAS 2 and AutoPulse that might also be of help.


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## MMiz

Informative post, thanks.  The Lucas website shares:



> Two pre-hospital randomized pilot trials (Smekal et al 2011 and Axelsson  et al 2006) have shown neutral results but improved ETCO2 values with  LUCAS (Axelsson et al 2010).



What value does the Lucas 2 offer the provider and community?  Is it simply a matter of minimizing the transition time from compressions to shocks?  It frees up providers to do other work?


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## NomadicMedic

We use the LUCAS 2 at my service and find, anecdotally of course, that we have a higher number of arrests that end in ROSC. We find we get outstanding ETCO2 numbers during a  code which is obviously from the excellent perfusion that LUCAS offers. And yes, it certainly frees up the medic for other things.  I can't imagine a code without the LUCAS. It really has changed our codes.


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## medicdan

n7lxi said:


> We use the LUCAS 2 at my service and find, anecdotally of course, that we have a higher number of arrests that end in ROSC. We find we get outstanding ETCO2 numbers during a  code which is obviously from the excellent perfusion that LUCAS offers. And yes, it certainly frees up the medic for other things.  I can't imagine a code without the LUCAS. It really has changed our codes.


Are you able to run codes with just 2 providers in the back now? Just 1? How soon after you arrive do you attach it?


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## NomadicMedic

If BLS is on scene doing CPR, we attach the LUCAS as soon as we get on scene. And we usually run a code with just two people. Intubated patients go on a vent, LUCAS does compressions... Frees the medic up for other stuff.


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## Jon

emt.dan said:


> Are you able to run codes with just 2 providers in the back now? Just 1? How soon after you arrive do you attach it?



How soon do we attach it? As soon as possible/practical. I've never been in a situation where CPR wasn't started, but it can be placed quickly, with minimal assistance.

In the event we transport a code, I have an Auto-vent and a Lucas. So yes, I can function in the back on my own, and even be in a seat belt while doing it.

Then again, the current guidelines and research lean towards reducing the transport of patients in cardiac arrest.


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## Jon

n7lxi said:


> If BLS is on scene doing CPR, we attach the LUCAS as soon as we get on scene. And we usually run a code with just two people. Intubated patients go on a vent, LUCAS does compressions... Frees the medic up for other stuff.



Medic: My Education Doesn't Include Compressions


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## NomadicMedic

Jon said:


> Medic: My Education Doesn't Include Compressions



Can I get this on a t shirt?


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## Jon

n7lxi said:


> Can I get this on a t shirt?



I saw it on a sticker once.

Sad part is it is true, especially in systems where there are a limited number of medics (Read: NOT California).


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## Handsome Robb

It's terrible to say but even as an intermediate I rarely do CPR. 

It's always fire doing compression and me pushing with drugs while my partner does his medic thing.


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## NomadicMedic

For me, Lucas does compressions while I do the medic thing. And frankly, that's the way I like it.


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## BandageBrigade

An quote from the AHA's 2010 update study.

"One multicenter, prospective, randomized controlled trial
comparing load-distributing band CPR (AutoPulse®) with
manual CPR for out-of-hospital cardiac arrest demonstrated
no improvement in 4-hour survival and worse neurologic
outcome when the device was used. Further studies are
required to determine if site-specific factors and experience
with deployment of the device could influence its efficacy.
There is insufficient evidence to support the routine use of
this device.
Case series employing mechanical piston devices have
reported variable degrees of success. Such devices may be
considered for use when conventional CPR would be difficult
to maintain (eg, during diagnostic studies).
To prevent delays and maximize efficiency, initial training,
ongoing monitoring, and retraining programs should be
offered on a frequent basis to providers using CPR devices."


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## Crizza

As a dedicated AutoPulse user with many saves on the AutoPulse, I wanted to reply to some of the marketing spin PC offered here. 



Thanks for your question. We actually think the differences between the LUCAS 2 and AutoPulse are quite significant. Consider, for example, the following:

Size & weight: LUCAS 2 weighs 22 lbs. (in carry case w/ extra battery) compared to the AutoPulse @ 39 lbs. (in carry case w/ extra battery). 

Your document shows that the AutoPulse weighs about 26lbs by itself.  Then it says the weight of the device is 39 lbs with an extra 5lb battery.  So the case weighs 8 lbs?  Is the LUCAS2 indicated for use with a soft stretcher?  If not, you ahve to use a backboard, right?  How much does your backboard weigh?  Shouldn't you add that to the total solution weight of the LUCAS2?  The AutoPulse can be used with a soft stretcher or a back board.  My service has found the soft stretcher offers more felxibility in getting the patient to the ambulance/cot



Batteries: Each AutoPulse battery weighs 5.1 lbs., lasts for approx. 30 minutes, and requires a 10-20 hour reconditioning cycle with every 10th use. The LUCAS 2 battery weighs 1.3 lbs., runs for approx. 45 minutes, can recharge in under 4 hours, and there are AC or DC auxiliary power supplies available for longer resuscitations. 

The LUCAS2 AC/DC power only trickle charges the battery.  It does not power the unit.  A plugged in LUCAS2 without a battery will not work.  A LUCAS2 with a depleted battery typically will not work either in my experience.  Please provide some documentation that proves your AC/DC power adapter can prolong the use during an arrest.



Total cost of ownership: Due to the high cost of the single-use, load distributing bands and the requirements for multiple spare batteries, the total cost of ownership for AutoPulse is approx. 25% higher over 5 years. 

Doesnt' PC advocate the replacement of the suction cup after every use?  I understand it costs less than the LifeBand, but you should at least be up front with that since it is in your product labeling.



Ease of use: The LUCAS 2 device can be applied in less than 20 seconds with minimal hands-off time. Defibrillator electrodes can be applied to patient after the LUCAS is deployed. 

My service can deploy the AutoPulse is 30 seconds so I see this as a nominal difference.  Your document overcomplicates the deployment of the AutoPulse


Durability: LUCAS 2 has an IP rating of 43. AutoPulse has an IP rating of 24.

This is the only proven advantage you listed.

Guidelines: The LUCAS 2 adheres closely to the AHA guidelines for Class IIa effective manual chest compression by providing continuous sternal compressions; at a rate of at least 100 compressions per minute; at a depth of at least 2”; and ensuring full recoil with a 50/50 duty cycle and a suction cup that assists the chest to the starting position. 

The AutoPulse has the same level of recommendation from the AHA with a higher level of evidence (IIb).


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## lawndartcatcher

I have personally used both the AutoPulse *and* the Lucas on the same patient; our service was test-driving the Lucas while we had the AutoPulse. 

~80F in cardiac arrest on our arrival; AutoPulse placed on backboard, patient placed on AutoPulse / backboard, and AutoPulse started. When we went to move her we had to bring her past the family with the AutoPulse thrashing her around like a fish (small house, no choice). Once we started going around our first turn and down the stairs the AutoPulse shut off - every time we mvoed her more than a couple of feet we it would shut off and we'd have to reposition her before we could start it again. 

Once we got her out to the truck I had one of the cops toss the Lucas into the back of the truck as we were loading her and off we went. The AutoPulse kept shutting off and we had to keep repositioning her; finally we pulled the AutoPulse off and were able to place the Lucas in less than 15 seconds (two guys in the back of a medium-duty rescue) and had mechanical compressions started within another 10 seconds. The quality of the compressions was immediately obvious - EKG waveform looked "normal", she started pinking up, and I could even feel faint peripheral pulses. At the hospital they used the portable sonogram to show the blood moving through the valves of the heart with the Lucas still on; I know the doctors and nurses were pretty impressed with it and they usually hate any kind of mechanical CPR device around here.

I have also been told that it can be used for traumatic arrests, which the AutoPulse can't. My service was one of the first around here to use the Lucas and we're using it as part of a CCR study; our current save rate is ten times the national average (~45%) under the study using the Lucas.


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## Medic Tim

lawndartcatcher said:


> I have personally used both the AutoPulse *and* the Lucas on the same patient; our service was test-driving the Lucas while we had the AutoPulse.
> 
> ~80F in cardiac arrest on our arrival; AutoPulse placed on backboard, patient placed on AutoPulse / backboard, and AutoPulse started. When we went to move her we had to bring her past the family with the AutoPulse thrashing her around like a fish (small house, no choice). Once we started going around our first turn and down the stairs the AutoPulse shut off - every time we mvoed her more than a couple of feet we it would shut off and we'd have to reposition her before we could start it again.
> 
> Once we got her out to the truck I had one of the cops toss the Lucas into the back of the truck as we were loading her and off we went. The AutoPulse kept shutting off and we had to keep repositioning her; finally we pulled the AutoPulse off and were able to place the Lucas in less than 15 seconds (two guys in the back of a medium-duty rescue) and had mechanical compressions started within another 10 seconds. The quality of the compressions was immediately obvious - EKG waveform looked "normal", she started pinking up, and I could even feel faint peripheral pulses. At the hospital they used the portable sonogram to show the blood moving through the valves of the heart with the Lucas still on; I know the doctors and nurses were pretty impressed with it and they usually hate any kind of mechanical CPR device around here.
> 
> I have also been told that it can be used for traumatic arrests, which the AutoPulse can't. My service was one of the first around here to use the Lucas and we're using it as part of a CCR study; our current save rate is ten times the national average (~45%) under the study using the Lucas.



what does your system consider a save?


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## lawndartcatcher

Medic Tim said:


> what does your system consider a save?



Walks out of the hospital.


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## Christopher

lawndartcatcher said:


> ...our current save rate is ten times the national average (~45%) under the study using the Lucas.



We don't use mechanical CPR and see the same rates of survival to discharge. We also work everybody on scene.


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## Handsome Robb

I'm assuming that save rate is for VF/VT arrests witnessed by EMS personnel...


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## Christopher

NVRob said:


> I'm assuming that save rate is for VF/VT arrests witnessed by EMS personnel...



Mine were, all comers is closer to 1 out of 5.


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## lawndartcatcher

NVRob said:


> I'm assuming that save rate is for VF/VT arrests witnessed by EMS personnel...



Nope. CCR pilot program.


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## izibo

lawndartcatcher said:


> Nope. CCR pilot program.



Your save rate is 45% for all patients? Witnessed *and* unwitnessed? Just VF/VT?


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## NomadicMedic

45% of all arrests? Seriously?

Call me a doubting Thomas, but I seriously question that claim.


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## Milla3P

I'm involved with 2 services. One has several AutoPulses has for 5-ish years. The other just purchased a Lucas 6 months ago. The Lucas has more ROSC events in 6 months than the AutoPulse had in 5 years. 
Lucas is MUCH easier to use as well. Less cumbersome. Used by cath labs, EDs ect. 

It's the better option.


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## lawndartcatcher

izibo said:


> Your save rate is 45% for all patients? Witnessed *and* unwitnessed? Just VF/VT?



"My service was one of the first around here to use the Lucas and we're using it as part of a CCR study; our current save rate is ten times the national average (~45%) *under the study* using the Lucas."

Study guidelines: cardiac (not respiratory or traumatic) arrests with a known down time. Read the studies performed by Bobrow and Ewy if you still don't believe me.

Our saves for all arrests is still around 15% (traumatic arrests rates are statistically low), which we credit to a) high numbers of trained bystanders / first responders (if you live or work in our town we'll teach you CPR for free) b) early adoption of mechanical CPR devices to ensure good quality, consistent compressions, and c) an aggressive field mentoring program (i.e. there's always at least two medics at every call and one of them has at least 10 years of experience).


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## Christopher

lawndartcatcher said:


> "My service was one of the first around here to use the Lucas and we're using it as part of a CCR study; our current save rate is ten times the national average (~45%) *under the study* using the Lucas."
> 
> Study guidelines: cardiac (not respiratory or traumatic) arrests with a known down time. Read the studies performed by Bobrow and Ewy if you still don't believe me.
> 
> Our saves for all arrests is still around 15% (traumatic arrests rates are statistically low), which we credit to a) high numbers of trained bystanders / first responders (if you live or work in our town we'll teach you CPR for free) b) early adoption of mechanical CPR devices to ensure good quality, consistent compressions, and c) an aggressive field mentoring program (i.e. there's always at least two medics at every call and one of them has at least 10 years of experience).



Those studies use Utstein Survival, which applies the condition of "witnessed, shockable initial rhythm" to the numbers reported. This isn't bad per se, but isn't the same as "All comers" survival or "All suspected-cardiac" or "All suspected-cardiac, known downtime".

I'm certain our numbers are lower due to the sheer number of "unknown downtime" arrests we work.


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## NomadicMedic

We recently started reporting our arrest data to the CARES registry and are now using the Utstein data to measure success. I'm sure we will be right up there with the other high performers, as we aggressively practice team resuscitation, use the Lucas on every code and and focus on effective CPR.


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## Crizza

We had similar problems with our AutoPulse shutting off.  It turns out we were not rotating our batteries properly.  After we started rotating them daily, we have not had any more issues.  I am not sure how battery management could affect the machine's sensor, but it seems to have fixed it.


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## Handsome Robb

lawndartcatcher said:


> Nope. CCR pilot program.



We do CCR and "pit crew" CPR as well. Although we don't use mechanical CPR devices.



n7lxi said:


> 45% of all arrests? Seriously?
> 
> Call me a doubting Thomas, but I seriously question that claim.



Agreed. Lawndart, not trying to say you are wrong but unless you can show me hard data I call BS. We also report to the CARES registry. 



lawndartcatcher said:


> "My service was one of the first around here to use the Lucas and we're using it as part of a CCR study; our current save rate is ten times the national average (~45%) *under the study* using the Lucas."
> 
> Study guidelines: cardiac (not respiratory or traumatic) arrests with a known down time. Read the studies performed by Bobrow and Ewy if you still don't believe me.
> 
> Our saves for all arrests is still around 15% (traumatic arrests rates are statistically low), which we credit to a) high numbers of trained bystanders / first responders (if you live or work in our town we'll teach you CPR for free) b) early adoption of mechanical CPR devices to ensure good quality, consistent compressions, and c) an aggressive field mentoring program (i.e. there's always at least two medics at every call and one of them has at least 10 years of experience).



What do you/your service qualify as a save? ROSC to admit? ROSC to discharge to SNF? Rosc to discharge neurologically intact? We can throw number around but without specifics that's all they are, numbers.

Why do you need 10 years of experience to be a good medic? Our longest standing field medic has 11 years at our company, not including supervisors and high level brass. I'd take some of the younger medics over the "oldschool" guys any day of the week. Just my opinion though.


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