automated cpr

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.
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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.
 
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 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.
 
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 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...
 
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? ;)
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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.
 
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
 
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.
 
Funny in that first video, they're holding a BVM to the face but not using it at all!
 
I ask to those that are using these devices have they noticed any difference in pt outcomes?
 
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.
 
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.
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I have to agree with this. While long transports may be benefited by this machine, it just scares me, personally.
 
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%).

Some cautions, though: Because the SFFD’s investigation was not designed as an outcome study, its methodology was not optimal—case-matching is a fairly imprecise way to compare results. Also, because it had only four devices, the department gave them to the roving supervisors, who responded to every arrest, but not with the first-arriving crews. “And that,” says Isaacs, is where youd expect that a device that provides tremendous CPR and doesnt fatigue, like a rescuer would, to have its greatest benefit—in the first few minutes of an arrest.

At roughly the same time, a study in Richmond, VA, was showing similar promise.2 This study compared ROSC percentages in adult non-traumatic cardiac arrests from five years before and six months following a switch to the AutoPulse. Investigators found that using the AutoPulse yielded a 74% relative increase in ROSC over standard CPR. This increase occurred regardless of the patients initial cardiac rhythm. Overall, ROSC for all patients increased from 21.6% to 37.5%.
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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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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.
 
Sasha said:
I've seen an autopulse used, and the worst thing for me is the sound.
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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:
 
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:
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Add that to the crunch of bone and my skin crawls.
 
More likely the crunch of cartilage!
 
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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