# automated cpr



## waemt09 (Jan 14, 2009)

so i was crusing the net and ran across this... not sure if its been discussed or not before, but I think it's pretty cool.
http://www.youtube.com/watch?v=jl0Oj5v3DHM


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## Juxel (Jan 14, 2009)

We use the Lucas Device in the hospital but in the field still do manual compression.  There is some debate about these devices causing harm to patients:.  It does burn through compressed air very quickly, which is a potential downside to using it in the field.


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## PapaBear434 (Jan 14, 2009)

Wow...  Another piece of equipment to carry and keep a battery (or compressed air) charged for!

The only real use I can find in the field for this is that short period of time of trying to get the stretcher out of the back and into the ER.  But have someone just ride on the side of the stretcher and it does about the same thing.


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## tydek07 (Jan 14, 2009)

Huh' have not seen that one before... They keep coming out with these devices and they have yet truly "caught on". Does this say something?


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## reaper (Jan 14, 2009)

Yes, It says that we are not truly looking at the benefit of their use!


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## stephenrb81 (Jan 14, 2009)

There are a couple of services around my region that use similar devices.  Some models can also link with some of the computerized run-sheet systems and defibrillators so vitals, CPR, marked-events on the monitor, etc.. are all automatically appended to the trip sheet (I'm thinking Zoll systems, but not entirely sure.)

I hear mixed reviews from people that have personally used them.  Some love them and swear by them.  Some complain that they have to be reset alot (apparently a safety system that stops it if the bands slip or slides on the torso).

I have personally seen one used once when I had requested an ALS intercept from a neighboring county.  My arms were glad to see it of course and once the medic set it up, it never once stopped/locked-up.  But I'm sure mileage will vary.


EDIT: I have also heard that some argue that the machine's compression are better than manual compressions because the machines actually "squeezes" the chest offering better perfusion compared to the standard "push down" compressions.  I have not been presented with any material substantiating that, just throwing it out there for consideration/debate.


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## waemt09 (Jan 14, 2009)

all the articles say it can deliver up to 80 pumps per minute for up to an hour.. the only benefit I see from carrying it along with the thousand other things on my rig I never use would be for a long transport that would require continuous CPR.  Then it would be a huge benefit to everyone I think. One would assume the machine won't get fatigued and stop performing as it did at the start.


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## reaper (Jan 14, 2009)

It also won't stop compressing while going through a doorway, loading the pt, hitting a pothole, and taking sharp corners!

 All codes should be worked at the scene. But for services that transport codes, they should be mandatory equipment.


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## Shishkabob (Jan 15, 2009)

Maybe I missed something... but how would an AEDbe used with that on?


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## Hockey (Jan 15, 2009)

Linuss said:


> Maybe I missed something... but how would an AEDbe used with that on?



Very carefully 

Was wondering the same thing though

Saw this device a week or so ago and thought it is great, but with a price tag it has, I don't see many services having it...


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## marineman (Jan 15, 2009)

The device in that video is the Zoll Autopulse. The service I ride with is one of 3 or 4 (i forget right now) study areas in the U.S. (I think Houston fire is one too). We have completely different PNB protocols for areas that the study is in effect. I've talked about it in another thread and discussed the comparison between this and the Lucas with one of the more experienced members in a thread in the Equipment area I believe. 

Works well, yes it automatically shuts off if the band slips down. Even a magical CPR machine does no good compressing the abdomen. The newer update machines do 100 compressions per minute, the old ones were set at 80. Several people have stated it's just more equipment, if either of the devices are able to provide better CPR than I am at all then I'd say it's a fantastic piece of equipment since all the drugs in that drug bag that you don't complain about, and that fancy 12 lead monitor won't save a life without quality CPR.

Edit: AED is used like normal, place pads before securing the "life band" and zap 'em. Unit is automatically set to do 30-2 for 3 minutes then will automatically pause so you can have an AED analyze or for the manual type folks out there you can check your underlying rhythm and shock if needed then hit the resume button and away it goes for another 3 minutes

Not only does it save me the effort of doing CPR and potentially provide more adequate CPR but now we're free to do those other fun skills that will add to the benefit rather than just pounding on the chest all day. We used to always bring a first responder in the rig to do compressions en route but with this we can leave them behind and have more room to move in the rig while doing other procedures. They do have some trouble points that are slowly being fine tuned and we'll have to wait and see what the study results say but considering every ambulance and every fire engine in our area got an autopulse put on it for free ($24,000 each) I'm ok with carrying it to save some work in the long run. We've never run long enough to test the batteries but the ones we're using (always have newest models) are said to last closer to 3 hours on continuous mode.


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## lightsandsirens5 (Jan 15, 2009)

Automatic CPR for my service = we arrive on scene and automaticly go into action.B)


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## Hockey (Jan 15, 2009)

I don't like that Zoll one for some reason.  This just looks much cooler 

http://www.youtube.com/watch?v=A8ROkFT07W8


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## waemt09 (Jan 15, 2009)

that other one looks kind of scary. lol.. something like you'd see in moving smashing someones head in, but that's how we all compress so why mess with that.  I would suggest reading the studies on these machines. They say it is a very valuable thing to have. What is the price tag on these? My only skepticism with this machine is it will make EMT's not necessarily lazy, but I can see some will relying on it solely as their only CPR option and never want to perform the real deal cpr.


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## tydek07 (Jan 15, 2009)

I guess I do not forsee these becoming widely used in EMS... at least not for awhile. 

The biggest concern of mine is that they appear to get in the way. How would you listen to lung sounds easily? Pt has a pneumo and you decompress, no longer can use this device. As other have mentioned, how would the pads (defib) effect it? And for those services out there that still use the paddles... hmm, in the way yet again. 

They just appear to be more of a pain then anything. Would they be nice to have, yes... if there were not so many negatives on them right now.

Take Care,

_***EDIT: I am talking about this specific device, the wrap around type. As, I have seen others out there that cover up less of the chest, therefor leaving more expossed for defib, lung soungs, etc etc._


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## PapaBear434 (Jan 15, 2009)

Yeah, I don't like this still.  My department has a lot of people, so there are plenty of people on hand during a code to trade off compressions.  I could see it being handy for long transports, but there are hospitals no more than fifteen minutes away from almost anywhere in my area...

So, I guess it would be great for small EMS departments with fewer people and longer distances between hospitals, but those people that could actually use it most are the least likely to afford it.  

Good idea, not that practical.


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## marineman (Jan 15, 2009)

One more time, Defib works exactly the same. You put patches on before securing the life band on the zoll. 1 button push and the life band comes loose enough that you can listen to the lower lobes of the lungs. Never seen a decompression done while using the autopulse so I don't know if the band would mess up the cath after or not. They aren't for everyone but most people that have used them love them. The lucas is apparently just as good or better but I have no experience with it.



PapaBear434 said:


> Yeah, I don't like this still.  My department has a lot of people, so there are plenty of people on hand during a code to trade off compressions.



How many people do you want to be tripping over in the back of the rig if you do transport a code? Ours keep getting smaller and smaller every time they get new ones so less people is definitely a good thing.


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## PapaBear434 (Jan 16, 2009)

We usually have three people in the back, one driving.  Two medics, one BLS to do compressions/bagging.  That way, only one medic is tied up doing the "regular" work of CPR and the other is free to play with all the fun drugs.

It works out pretty well, actually.


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## marineman (Jan 16, 2009)

that's what we used to do but our new rigs are city medix mini mods that have the cot against the wall and no CPR seat. only the jumpseat and the bench. no room to get by someone doing CPR if needed. As long as you have an effective system no need to change it but the Autopulse works great for us.


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## bowulf (Jan 16, 2009)

We are actually starting a 1 or 2 month demo of the same device as well.  Our unit should be here in 2 weeks, and the Lucas rep should be here to with our medical director to write temporary standing orders for the medics.


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## PapaBear434 (Jan 16, 2009)

bowulf said:


> We are actually starting a 1 or 2 month demo of the same device as well.  Our unit should be here in 2 weeks, and the Lucas rep should be here to with our medical director to write temporary standing orders for the medics.



Keep us posted on this, then.  I am completely unsold on this idea, but I'm open to new ideas, especially if fellow EMT's approve.


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## Labareda (Jan 17, 2009)

Hmm.. I'm not sure how this works. What if the patient is a child instead of an adult. Does it adjust the pressure of the compressions? Lets see, we can't allways aply the same pressure to every patient, does the machine calculate it accurately?


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## marineman (Jan 17, 2009)

I can't speak for the lucas but the zoll determines the chest size when the band is applied, then compresses a certain percentage of that.


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## csly27 (Jan 18, 2009)

I dont know personally they both creep me out. I would much rather do it the old fashion way i guess you could put it. At least then I know it would be done right and not having to worry about malfunctioning or what ever else could possibly go wrong.


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## daedalus (Jan 18, 2009)

I look forward to more widespread use of the autopulse. I am jealous of those that have them I hate doing compressions! Although it is a good work out...


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## NolaRabbit (Jan 18, 2009)

Labareda said:


> Hmm.. I'm not sure how this works. What if the patient is a child instead of an adult. Does it adjust the pressure of the compressions? Lets see, we can't allways aply the same pressure to every patient, does the machine calculate it accurately?



I don't have any experience with the Zoll, but my service field tested the Lucas for several months. We loved it, wished we had bought one or two. 

You don't use it on kids. To measure compression depth, you simply placed the pressure point on top of the patient's sternum and then locked it into position. The machine then can calculate the depth. It worked frighteningly well, with awesome waveform on the monitor. The best part was that it left your hands free for your other interventions.


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## eggshen (Jan 19, 2009)

We use the Lucas Device in the hospital but in the field still do manual compression. There is some debate about these devices causing harm to patients:. It does burn through compressed air very quickly, which is a potential downside to using it in the field.
__________________
What kind of harm can one truly cause another that is, well....dead?

Egg


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## frdude1000 (Mar 8, 2009)

Our service does not have a thumper.  We do it old fashioned style with some good old elbow grease!  I know services that do use it, too.  Its mostly good for over 15 min transports.


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## spnx (Mar 8, 2009)

Funny in that first video, they're holding a BVM to the face but not using it at all!


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## VentMedic (Mar 8, 2009)

spnx said:


> Funny in that first video, they're holding a BVM to the face but not using it at all!


 
Look again and watch closely.


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## artman17847 (Mar 8, 2009)

I ask to those that are using these devices have they noticed any difference in pt outcomes?


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## medic417 (Mar 8, 2009)

Considering Codes are usually stopped after 20 minutes is there really enough justification for this?  I mean unless it is proven to improve outcomes from unwitnessed arrest what is the real point.  By the time someone runs out to the amblance gets it brings it back sets it up code is basically over.


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## Tmurphy (Mar 8, 2009)

csly27 said:


> I dont know personally they both creep me out. I would much rather do it the old fashion way i guess you could put it. At least then I know it would be done right and not having to worry about malfunctioning or what ever else could possibly go wrong.



I have to agree with this. While long transports may be benefited by this machine, it just scares me, personally.


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## Sasha (Mar 8, 2009)

I've seen an autopulse used, and the worst thing for me is the sound. I also have to wonder if it causes spinal trauma with all that compression. However, there are a some studies showing it to be beneficial in non traumatic cardiac arrest.

*AutoPulse Cardiac Pump Shows Promise in Pair of EMS Studies*
Full article here: http://www.emsresponder.com/print/EMS-Magazine/AutoPulse-Cardiac-Pump-Shows-Promise-in-Pair-of-EMS-Studies/1$1847


> The department deployed the AutoPulses with paramedic supervisors who used them when they encountered arrests in progress. Using age, gender and length of resuscitation efforts, results from the AutoPulse cases were then compared to results from comparable cases in which standard CPR was used, with a primary endpoint of patient arrival at the ED with spontaneous circulation.
> 
> The AutoPulse showed an improvement: 39% of patients on whom it was used had ROSC upon ED arrival, while 29% of regular-CPR patients did. This improvement was clearest among those with initial presenting rhythms of asystole (37% vs. 22%) or pulseless electrical activity (38% vs. 23%).
> 
> ...



And while this study doesn't address the autopulse specifically, it addresses "Vest CPR" which is, to my understanding, has the same goal as the autopulse, providing circumferential compressions.

*A Preliminary Study of Cardiopulmonary Resuscitation by Circumferential Compression of the Chest with Use of a Pneumatic Vest
*
Full article here:http://content.nejm.org/cgi/content/full/329/11/762


> Results In phase 1 of the study, vest CPR increased the peak aortic pressure from 78 ±26 mm Hg to 138 ±28 mm Hg (P<0.001) and the coronary perfusion pressure from 15 ±8 mm Hg to 23 ±11 mm Hg (P<0.003). Despite prolonged unsuccessful manual CPR, spontaneous circulation returned with vest CPR in 4 of the 29 patients. In phase 2 of the study, spontaneous circulation returned in 8 of the 17 patients who underwent vest CPR as compared with only 3 of the 17 patients who received continued manual CPR (P = 0.14). More patients in the vest-CPR group than in the manual-CPR group were alive 6 hours after attempted resuscitation (6 of 17 vs. 1 of 17) and 24 hours after attempted resuscitation (3 of 17 vs. 1 of 17), but none survived to leave the hospital.
> 
> Conclusions In this preliminary study, vest CPR, despite its late application, successfully increased aortic pressure and coronary perfusion pressure, and there was an insignificant trend toward a greater likelihood of the return of spontaneous circulation with vest CPR than with continued manual CPR. The effect of vest CPR on survival, however, is currently unknown and will require further study.


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## karaya (Mar 8, 2009)

Thank you Sasha for posting the information about the Auto Pulse. You saved me a lot of writing!

I've been privileged to see the AutoPulse in use on at least 40 to 50 patients in the last few years. I was also on hand to photographically document the first cardiac save in Missouri whereby an AutoPulse was used.

Without going into a lot of detail to my past experiences with manual CPR, my experience watching the outcome of patients with the AutoPulse was jaw dropping. When I saw it in use the very first time, the crew had pulse on the patient within two minutes of use. Okay, I thought, things just went right for this guy. But then the second and third arrest I witnessed produced the same results. Crews were palpating pulses from the patient in a few minutes of use with the Auto Pulse.

The bottom line is the AutoPulse is far more efficient in CPR than any human can be; therefore, providing far better circulation using circumferential compressions. The results were so compelling, my host provider purchased 30 units for all of their ambulances. The experiences with the AutoPulse was also shared with me in upstate New York when I was on location photos documenting several EMS providers there. They too had such positive results with their demo units that AutoPulses were eventually purchased for all of their ambulances as well.

In addition to pre-hospital, there has been a dramiatic increase in the purchase of AutoPulses for EDs and ICUs.


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## LucidResq (Mar 8, 2009)

Sasha said:


> I've seen an autopulse used, and the worst thing for me is the sound.



It sounds like a creaky bed rhythmically rocking. The firefighters were training on autopulses in the room next to me one day and I thought they were doing naughty things. :wacko:


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## Sasha (Mar 8, 2009)

LucidResq said:


> It sounds like a creaky bed rhythmically rocking. The firefighters were training on autopulses in the room next to me one day and I thought they were doing naughty things. :wacko:



Add that to the crunch of bone and my skin crawls.


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## reaper (Mar 9, 2009)

More likely the crunch of cartilage!


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## spnx (Mar 9, 2009)

VentMedic said:


> Look again and watch closely.



Meant to say when they're moving him to the unit.

It is pretty grainy though - I might have missed it - the video gets pretty blocky.


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## TransportJockey (Mar 9, 2009)

The service I used to work for had Zoll Autopulses for the county they operated in with the farthest transport time. Their primary use for it was a pt with ROSC that coded again in transport. 2 of 3 of their trucks are Type IIs, with the third being a Type I, but with only two person crews and most FDs in that county are Vollie where you're lucky if you have another EMT-I on scene, they consider them essential pieces of equipment.


My cardiac instructor is not a fan of them though... He just considers them a waste of money. I tend to sit on the fence for that one until more hard data is out on them


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## Sasha (Mar 9, 2009)

reaper said:


> More likely the crunch of cartilage!



Well it's the crunch of something, and whatever it is makes my skin crawl!


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## karaya (Mar 9, 2009)

Sasha said:


> Well it's the crunch of something, and whatever it is makes my skin crawl!


 
I've seen these things in use a few dozen times. All kinds of patients, all kinds of ages, all kinds of sizes; never heard a crunching sound. You sure someone wasn't eating a Kit Kat bar during the code?


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## Sasha (Mar 9, 2009)

karaya said:


> I've seen these things in use a few dozen times. All kinds of patients, all kinds of ages, all kinds of sizes; never heard a crunching sound. You sure someone wasn't eating a Kit Kat bar during the code?



That must have been it! Haha. Maybe it was something else that was crunching, whatever HAD been the cunchy sound was not a sound I want to hear!


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## Jeremy89 (Mar 10, 2009)

Why would you continue compressions if you had a defib/monitor?  Couldn't you use the "pace" function?  Or is that just a hospital thing?


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## TransportJockey (Mar 10, 2009)

Jeremy89 said:


> Why would you continue compressions if you had a defib/monitor?  Couldn't you use the "pace" function?  Or is that just a hospital thing?



If you're pacing, it's a slow rhythym, but it's a spontaneous rhythym. If you're doing compressions, it's usually very fast or flatline, either way with no pulse


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## Ridryder911 (Mar 10, 2009)

Jeremy89 said:


> Why would you continue compressions if you had a defib/monitor?  Couldn't you use the "pace" function?  Or is that just a hospital thing?



Pacing is an electrical thing, heart contraction is a mechanical thing. Kinda like a battery in a car may spark but if the engine does not turn over, there is no power. (very simplified) 

No, we have external pacemakers in EMS. 

R/r 911


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## NRNCEMT (Apr 29, 2009)

I think well trained personel can do the same job and save a department $15,000 + the $125 compression bands.


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## Ridryder911 (Apr 29, 2009)

NRNCEMT said:


> I think well trained personel can do the same job and save a department $15,000 + the $125 compression bands.



Although, I agree of the savings, research has proven that humans cannot compare with the same effectiveness as the machine.

R/r 911


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## nomofica (May 8, 2009)

Linuss said:


> Maybe I missed something... but how would an AEDbe used with that on?



Perhaps place AED leads on before completely strapping them in? Although the electrodes would put some pretty nice bumps in their chest from the compressions...


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## Simusid (Nov 12, 2009)

artman17847 said:


> I ask to those that are using these devices have they noticed any difference in pt outcomes?



This is essentially my question as well, with a twist.  My service currently has an Autopulse on each truck.  We have had them for about 4 years and the general feedback has been positive.  However, we have found that we spend quite a bit of $$ on replacement batteries and the bands are over $100 each.

We are now considering the pneumatic LUCAS Thumper, because of the lower cost of consumables and also because it allegedly does better compressions than the AutoPulse.

So my question is not about manual compressions vs auto, it is about AutoPulse vs LUCAS Thumper.  Does anyone have any experience with both devices?   Which would you prefer and why?


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## firemedic1563 (Nov 17, 2009)

NRNCEMT said:


> I think well trained personnel can do the same job and save a department $15,000 + the $125 compression bands.




My department recently started implementing the LUCAS. We trialed them, Thumpers(we currently have on all ALS units), and the Autopulse. I did not personally get to use the autopulse, but my understanding of our choice was that we had many times it stopped, and some sort of pin failure in the connection, as well as the cost per use. Here are some of our reasons, and some that I am a proponent now:

1. The problem with the above quote, is that NO, a well trained provider CANNOT do the same job. As evidenced in the study below, in a hospital setting (no moving up/down stairs, tight spaces, etc) at one minute effectiveness of compressions was about 92%, by 3 minutes, only about 40% and less than 20%effective after 5 minutes. Even when switching often, fatigue quickly reduces any humans compressions.
Manual CPR Study

2. Studies have shown a dramatic increase in neurologically intact survival when placed early, along with early bystander CPR (a key).LUCAS Study

3. The LUCAS has been shown to increase the cerebral as well as coronary perfusion dramatically over manual CPR, in large part due to the increaed negative interthoracic pressures thanks to the better recoil with the suction like effect.Hemodynamic efficacy

4. Provider safety. Unfortunately we still transport most arrests unless they have rigor set in. Our industry kills/injures way to many of us in crashes. Do we really need an unrestrained provider doing compressions on a patient when even with possible improved outcomes, survival is highly questionable?

5 It provides consistent depth 100% of the time. AHA recommends 1 1/2" to 2". It is not designed for children or very small adults. 

None of this is to say it is effective for all patients, fits all patients, or will save the dead. Nor will many areas be able to afford it. But to dispell a promising innovation because it looks barbaric or because we think we do as good a job is a disservice IMHO.


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## Hal9000 (Nov 17, 2009)

firemedic1563 said:


> My department recently started implementing the LUCAS. We trialed them, Thumpers(we currently have on all ALS units), and the Autopulse. I did not personally get to use the autopulse, but my understanding of our choice was that we had many times it stopped, and some sort of pin failure in the connection, as well as the cost per use. Here are some of our reasons, and some that I am a proponent now:
> 
> 1. The problem with the above quote, is that NO, a well trained provider CANNOT do the same job. As evidenced in the study below, in a hospital setting (no moving up/down stairs, tight spaces, etc) at one minute effectiveness of compressions was about 92%, by 3 minutes, only about 40% and less than 20%effective after 5 minutes. Even when switching often, fatigue quickly reduces any humans compressions.
> Manual CPR Study
> ...



Excellent post.  I know some areas which have used it and loved it, and its ability to outperform a human is indeed very striking.  I got to try the Autopulse once and was very impressed.


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## firemedic1563 (Nov 19, 2009)

Saw this today in JEMS. Although the improved survivals are attributed to the hypothermic therapies, it is interesting to note that the program uses "mechanical" cpr.

http://www.jems.com/news_and_articles/news/09/vcu_medical_center_and_richmond_ambulance_authority_partner_in_unique_effort.html;jsessionid=5909E05EB78C7928732E9B04B732D22A


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## mcdonl (Jul 28, 2010)

Last weekend I was was grabbing the vac mat out of the side compartment and saw an auto-pulse out of the corner of my eye...

We did training on it last night. Pretty cool. We sometimes only get 1 or 2 people to work a code, and we have a 35 minute transfer to the trauma center.


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## Aidey (Jul 28, 2010)

If they are dead at the beginning of the transport, what makes you think they will improve during the next 35 minutes?


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## mcdonl (Jul 28, 2010)

Aidey said:


> If they are dead at the beginning of the transport, what makes you think they will improve during the next 35 minutes?



Persistence? I didn't buy it, I don't make our rules and I have never used it. Just thought it was neat and when asked why we have it and how it works I was answered.


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## Aidey (Jul 28, 2010)

Rule? You have a rule that you have to transport all cardiac arrest patients?


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## MrBrown (Jul 29, 2010)

We used the "Thumper" in the early 1990s; it was a blue bellow pump type thingo designed for mechanically assisted chest compressions.

It is sported here in its blue carry bag by a very suave and dashing medicino


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