automated cpr

[Sasha]

More likely the crunch of cartilage!

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

 

[karaya]

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?

 

[Sasha]

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!

 

[Jeremy89]

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?

 

[TransportJockey]

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

 

[Ridryder911]

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

 

[NRNCEMT]

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

 

[Ridryder911]

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

 

[nomofica]

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...

 

[Simusid]

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?

 

[firemedic1563]

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.

 

[Hal9000]

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.

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.

 

[firemedic1563]

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

 

[mcdonl]

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.

 

[Aidey]

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

 

[mcdonl]

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.

 

[Aidey]

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

 

[MrBrown]

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