How many codes make it?

[18G]

Most recent data on the LUCAS is that it's as good but no better than perfect-quality manual compressions.

It is well recognized that chest compressions performed by all levels of health care providers has been lacking. In a field environment where patient's are taken down three flights of stairs or carried a long distance out of the woods or just in a single story home, it is near impossible to maintain quality compressions without interruptions.

If we could guarantee perfect manual chest compressions that would be one thing but we can't. This is why automatic compressions devices are great.

 

[Brandon O]

Yeah. I'm as-yet undecided as to whether to allow the "oh well, people will never be perfect" cop-out into my life. Time will tell.

However, a device to provide compressions while transporting will never be convincing to me until someone can articulate why we need to be transporting codes anyway. The one left-field possibility here is if we start hauling some of these people -- the MI-induced arrests (determined by whatever criteria) -- into the cath labs to receive PCI prior to ROSC, in which case there would be a legitimate need for compressions not only during transport but on the table as well. But this is far from routine in most areas.

 

[mycrofft]

OP, not very darn many, but depends on etiology too.

Massive MI with END or electrical systole: zero.
Pulselessness and apnea due to electric shock or some other non-CAD cause, much higher.
Our FD EMS medical controller tells us since the 2010 changes to CPR, we are actually seeing some sort of upswing in CPR survival rates; to tell you the truth, however, many places seem to have different standards for "survival", each seems to make that institution look better than others'.

 

[Smash]

I don't agree. Evidence show's that high quality and continuous chest compressions contribute to higher success rates with ROSC. With knowing this, how would a device that provides continuous and perfect chest compressions not be beneficial? As was already stated, these devices eliminate pauses during the move from scene to ambulance and they enable quality compressions during transport.

I agree that the hypothesis is a good one, however the studies to date do not support it, and it is a post hoc fallacy to believe that one follows the other. In fact one trial (ASPIRE) was stopped early due to such poor outcomes in the automated device arm. There are some retrospective studies that suggest (after much data jiggery-pokery) that automated devices are good, but the only prospective trials done show either no difference, or worse outcomes (although there are methodological flaws with these as well)
Just because something seems intuitively better, doesn't mean it is, as we see all the time with, well pretty much any intervention in the last 30 years you care to name!

And with the use of EtCO2, if an arrest patient has a good value indicating decent cellular metabolism then why not provide resuscitation longer (ie transport)?

To what end? EtCO2 is certainly useful in calling off arrests, however it does not hold that the opposite is true. I could be wrong, but I am not aware of any data suggesting that the surrogate measure of an EtCO2 number is any use in determining whether transport is initiated or not. I admit that I will crack on for longer if I am seeing good numbers, but I still do not, and will not, transport dead people unless there is some strange, compelling reason to do so. The benefits are too small and the risks too great.

I typed that kind of quickly....i meant its nice to have (LUCAS) enroute when its just you or your partner in the back

Oh, ok. In my experience, rearrest is due to one of two things. First, the initial insult was just too great to survive. Or second, post-ROSC care was substandard.

 

[Smash]

However, a device to provide compressions while transporting will never be convincing to me until someone can articulate why we need to be transporting codes anyway.

Well put.

The one left-field possibility here is if we start hauling some of these people -- the MI-induced arrests (determined by whatever criteria) -- into the cath labs to receive PCI prior to ROSC, in which case there would be a legitimate need for compressions not only during transport but on the table as well. But this is far from routine in most areas.

Interestingly enough we are currently running a pilot study to determine the feasibility of a large scale trial to look at that. I have no idea how it is going, or when it will be complete though. Of course, what we are looking at here is saving those we know we can save anyway: the healthy, young dead person. We know we can't save the unhealthy, old dead person. Maybe saving the healthy dead better will be good. (If that makes any sense)

 

[Brandon O]

I am made to understand that some of the cath lab folks are opposed to this practice, on the grounds that bringing in dead people would throw their stats. I find this very dumb.

 

[epipusher]

15 years, approx. 10k runs. 2 have walked out 100% neurologically intact.

 

[Shishkabob]

It is well recognized that chest compressions performed by all levels of health care providers has been lacking. In a field environment where patient's are taken down three flights of stairs or carried a long distance out of the woods or just in a single story home, it is near impossible to maintain quality compressions without interruptions.

If we could guarantee perfect manual chest compressions that would be one thing but we can't. This is why automatic compressions devices are great.

I went to EMS Expo here in Dallas last year, and at the Physio-Control booth they had a thing where they pitted the Lucas against a person. Clearly most people did worse than the Lucas... but I was there for one guy who did 2 minutes straight of PERFECT chest compressions... beating the Lucas. Even the rep stated she's never seen that done before :rofl:

 

[usafmedic45]

Just curious, for all of you verterans out there, how many codes that are resucitated actually live to walk around and have a normal(or not normal) life?

Not enough.

 

[usafmedic45]

I went to EMS Expo here in Dallas last year, and at the Physio-Control booth they had a thing where they pitted the Lucas against a person. Clearly most people did worse than the Lucas... but I was there for one guy who did 2 minutes straight of PERFECT chest compressions... beating the Lucas. Even the rep stated she's never seen that done before :rofl:

I'm glad I could be so impressive.

 

[mycrofft]

At 100 plus a minute and at least 2 inch depression...

I could do about, say, ninety seconds'.
I have seen one resuscitate, she had coded choking on food while at the table and was still slumping there, and we responded from the ambulance company two blocks away. She has resumed spontaneous pulse and resp, and we had the bolus of food in the trash when 1/2 way to hospital, got radio phone order for DNR (haha, too late) , she was up on Tele three days later and eventually left the hospital, to live ]away from her knucklehead offspring.

PS: last post, I typed EMD but Mac Mini made that END.

 

[DarkStarr]

About 4-5 weeks ago I responded QRP to a 93 y/o m in cardiac arrest on the other side of town (about 2 miles). Wife said he had only been about about 4 to 5 minutes and wanted everything done. I got out my BVM and began CPR until the ambulance got there. He was ROSC without electricity (asystole on scene) and they had only given him 2 rounds of Epi. He's still alive as I type this.

 

[Smash]

About 4-5 weeks ago I responded QRP to a 93 y/o m in cardiac arrest on the other side of town (about 2 miles). Wife said he had only been about about 4 to 5 minutes and wanted everything done. I got out my BVM and began CPR until the ambulance got there. He was ROSC without electricity (asystole on scene) and they had only given him 2 rounds of Epi. He's still alive as I type this.

Nice job. One question: alive how? On a vent? Being watered twice a day? Or playing beach volleyball? At 93, I'm picking the arrest didn't make him any healthier, nor any less of a burden on the healthcare system.

 

[CAOX3]

Nice job. One question: alive how? On a vent? Being watered twice a day? Or playing beach volleyball? At 93, I'm picking the arrest didn't make him any healthier, nor any less of a burden on the healthcare system.

Who cares?

Your job isn't to determine whats in the best interest of the healthcare system.

Its about the wishes of the patient, if they choose to live on a vent for the rest of their life that's their decision, one that should have been thoroughly discussed beforehand.

My job is to simply ascertain that goal.

Im not looking to solve the financial and moral aspects of the health care system, you want a pulse back, I will do everything in my power to give you one. Its your responsibility to decide decide beforehand if you wish to live with the ramifications of those decisions.

 

[mycrofft]

The pt cares...I hope.


I think NIH should define resuscitation' outcome then force health providers to use those when they start spouting about "survival", and the originating site should be listed as well as the precise location where the pt was declared, or went pulseless at least, no turfing fatalities to IFT's and ED's.