Does anybody prefer those automatic CPR devices?

[traumaluv2011]

I know my squad has one, but one of the members that was on the squad for two years said that we've never used it. He said some of the county paramedics use it, some don't. They all are provided one and based out of the hospitals (so there are like 10 units).

My book talks about using them, but I haven't seen them ever used. It talks about two specific modeal, the Thumper and the Auto-Pulse, but I'm sure there are more. I think the reason that nobody uses them is it takes like a minute to set up a patient on them. And if they are under cardiac arrest, you aren't going to want to stop CPR any longer than 20 seconds.

Does anybody ever use these?

 

[ArcticKat]

I've used the Zoll Autopulse once. It was actually quite convenient. If the studies are to be believed, then a medic could be risking a misfeasance case for not using the device if it is available.

http://www.zoll.com/uploadedFiles/Public_Site/Products/AutoPulse/Krep_AutoPulse_Resuscitation.pdf

 

[Tigger]

I know my squad has one, but one of the members that was on the squad for two years said that we've never used it. He said some of the county paramedics use it, some don't. They all are provided one and based out of the hospitals (so there are like 10 units).

My book talks about using them, but I haven't seen them ever used. It talks about two specific modeal, the Thumper and the Auto-Pulse, but I'm sure there are more. I think the reason that nobody uses them is it takes like a minute to set up a patient on them. And if they are under cardiac arrest, you aren't going to want to stop CPR any longer than 20 seconds.

Does anybody ever use these?

I played with the thumper once (made by I think Lucas?) and I can't imagine it taking a minute to get it properly positioned. It did take some time to setup, but I think you would ideally have someone doing "regular" compressions while someone else sets the device up. The thing I really didn't like about the thumper was that it was air powered. That meant someone had to carry an scab bottle in, and most ambulances don't have a way to secure that kind of cylinder during its use.


Sent from my out of area communications device.

 

[dstevens58]

Here's a story from a nearby agency that runs a lot of mutual aid with our volunteer department, as they have ALS and we have BLS. I don't know the brand name, but I know the paramedic.

 

[traumaluv2011]

That's actually a pretty convincing story. Maybe I should take a couple minutes to familiarize myself with ours. If we get a call for an unresponsive/apneic or CPR in progress, I know we'll get at least four of our members to the scene. So it wouldn't be a problem setting it up.

 

[usalsfyre]

I've used the Zoll Autopulse once. It was actually quite convenient. If the studies are to be believed, then a medic could be risking a misfeasance case for not using the device if it is available.

http://www.zoll.com/uploadedFiles/Public_Site/Products/AutoPulse/Krep_AutoPulse_Resuscitation.pdf

Alternately, if you believe the CRUSADE trial then a medic could be seen as negligent for using it at all.

It's going to take a lot more good data than is currently available to convince me of the usefulness of these devices if your following AHAs reccomendations.

 

[NomadicMedic]

Lucas device. Every code.

 

[STXmedic]

lucas device. Every code.

+1.

 

[Shishkabob]

Does anybody prefer those automatic CPR devices?

We call them "Firefighters" around here

 

[WolfmanHarris]

We've been trialing the LUCAS 2 on five of our vehicles (out of 35-40 depending on deployment) based out of our more outlying stations with the longest potential transport times to hospital.

I've used it once on a code (before I bid into a station that's not part of the trial) and loved it.

If we leave aside the research on effectiveness, where the jury is very much still out, there is still convincing evidence to use it. Certainly in a progressive system cardiac arrests are generally not transported, and the vast majority of those in my region are not. But there are times when transport may be required and in those cases having a device to do proper depth and rate compressions while all crew members remain belted becomes well worth the cost.

If we consider calls where there may be limited hands or space a CPR device may also be worthwhile to counteract tired or distracted providers. We can do alot in our practice to try and improve our flow and direction of cardiac arrests, but there will always be room for human error that will increase hands off time, cause rate and depth to fall out of recommended parameters or cause less than full recoil. I see a CPR device as being key for limiting these.

Prior to the arrest I used the LUCAS 2 on, I ran through in my head where in my call I saw the device being utilized and how. I took about 20 minutes in the truck (outside of the CME session we'd already had on the device) to re-familiarize myself with it. I determined the easiest way to work it in would be after the third rhythm analysis on a PCP arrest (BLS) I would place the back plate at the same time we were rolling the Pt. onto the board. Without hesitation the next FF would jump back on the chest while I adjusted the plate and prepared the rest of the device (and the others FF's secured the strap while my partner continued to manage the airway and ventilate). Once I was ready with the device I positioned it above the Pt. and called for a halt to compressions. From there the device was engaged in less than ten seconds from the halt. From here the Pt. could be carried down stairs to the stretcher without any halt in compressions.

Certainly the devices can seem klunky and a further distraction to a call that has already been shown to have worse outcomes the more and more we get distracted from good compressions, but I think with communication and forethought it can actually improve the efficiency of the call.

Beyond that I wait for conclusive evidence of it's impact on outcomes.

 

[feldy]

Lucas device. Every code.

same here.

 

[abckidsmom]

I will confess to not having read any studies about Ethe dangers of the autopulse, but when we rolled them out in our system about 10 years ago, they doubled our ROSC rate, and added significantly to the survival to discharge rate, though I can't recall those numbers offhand.

All I can say is that extreme diligence to make sure well-performed CPR is happening all the time is imperative, and without a strong focus on well performed CPR, you might as well not do anything at all.

I can think of several arrests before the change in the trend that totally would have had a chance now, at least to be donors, that we squandered with stopping for pulse checks.

 

[Hunter]

I have an instructor who says that anytime they use an Auto Pulse they always have had ROSC vs having someone else do compressions, but maybe that's just coincidence.

 

[BEorP]

I will confess to not having read any studies about Ethe dangers of the autopulse, but when we rolled them out in our system about 10 years ago, they doubled our ROSC rate, and added significantly to the survival to discharge rate, though I can't recall those numbers offhand.

I would suggest that if the survival to discharge actually improved as a result of the AutoPulse that this should be published somewhere. There has yet to be convincing evidence that mechanical CPR improves survival to discharge.

 

[BEorP]

If we leave aside the research on effectiveness, where the jury is very much still out, there is still convincing evidence to use it. Certainly in a progressive system cardiac arrests are generally not transported, and the vast majority of those in my region are not. But there are times when transport may be required and in those cases having a device to do proper depth and rate compressions while all crew members remain belted becomes well worth the cost.

Other than not having an ACP on scene, why do you find that cardiac arrests are being transported most commonly?

Obviously your employer will be particularly concerned about paramedic safety after the incident a few years ago, but these are still expensive devices without efficiency for their efficacy in helping patients more than manual CPR. When the rare cardiac arrest patient has to be transported, why not just do it without lights, sirens and crazy driving instead?

 

[Bullets]

i wish we had them, it would save us a lot of work when we transport a patient with a 50min down time because they still present with PEA

 

[dixie_flatline]

I like them in theory. In practice using our autopulse, I've seen issues with batteries fairly frequently. Also, a fair number of non-traumatic arrests are... larger, and we have seen cases where the band fails.

 

[mcdonl]

We have an autopulse on each unit but the state just pulled them. They are doing a trial with them at a local hospital, but in the mean time we are not allowed to use them.

Make sure that there is a battery swap as a part of the truck check because it sucks when you need one and the battery is dead.

 

[dixie_flatline]

Make sure that there is a battery swap as a part of the truck check because it sucks when you need one and the battery is dead.

we do change out the batteries as part of the daily. The issues I've seen are both batteries not holding charges, as well as apparently full batteries becoming disconnected during use. Some medics have speculated that the violent pulling action might be overcoming the latches holding the battery in place (especially in conjunction with moving pt and other providers starting lines, establishing airways, etc).

 

[STXmedic]

We have an autopulse on each unit but the state just pulled them. They are doing a trial with them at a local hospital, but in the mean time we are not allowed to use them.

Make sure that there is a battery swap as a part of the truck check because it sucks when you need one and the battery is dead.

Lucas plugs in to the outlet in the patients home Buy yes, daily checks on battery level and carry two batteries (good for about 45min of CPR per battery)