LUCAS 2 Ad: "improve patient's chance for a successful outcome"

[BEorP]

I am a pretty strong supporter of Physio-Control and satisfied user of the products you put out. The LP12 and 15 are wonderful devices, and the LUCAS 2 was certainly designed with paramedics in mind. Though I admit maybe not being up on the most curent reviews, last I heard the jury was still very much out on the efficacy of mechanical CPR in terms of improving patient outcomes. I was a bit surprised to recently came across this ad for the LUCAS 2:

There are lots of ways to sell mechanical CPR. You can say that it protects paramedics while transporting cardiac arrests or delivers what we would think to be an optimal compression or seems to improve cerebral perfusion or maybe even ROSC rates and have evidence to support this. Has there been good quality research that actually confirms that patients treated with the LUCAS 2 have better outcomes? (survival to hospital discharge)

It would be great if you can point me to the studies I should be reading to bring myself up to speed on the most current research on the LUCAS 2!

 

[DrParasite]

I believe (and I could be waaaay wrong here) that the Lucas 2 provides the same depth and consistent uninterrupted compression, regardless of circumstances (bump in the road, carrying down stairs, after 10 minutes of compression you are really tired, taking patient out of the ambulance and wheeling into the ER, etc), which is the concept behind the hard and fast science of CPR leading to improved patient's chance for a successful outcome.

 

[Physio Control]

I am a pretty strong supporter of Physio-Control and satisfied user of the products you put out. The LP12 and 15 are wonderful devices, and the LUCAS 2 was certainly designed with paramedics in mind. Though I admit maybe not being up on the most curent reviews, last I heard the jury was still very much out on the efficacy of mechanical CPR in terms of improving patient outcomes. I was a bit surprised to recently came across this ad for the LUCAS 2:

There are lots of ways to sell mechanical CPR. You can say that it protects paramedics while transporting cardiac arrests or delivers what we would think to be an optimal compression or seems to improve cerebral perfusion or maybe even ROSC rates and have evidence to support this. Has there been good quality research that actually confirms that patients treated with the LUCAS 2 have better outcomes? (survival to hospital discharge)

It would be great if you can point me to the studies I should be reading to bring myself up to speed on the most current research on the LUCAS 2!

Thanks for your question. We recognize that the entire system of care is vital to improving patient outcomes – early defibrillation, consistent and effective CPR, therapeutic hypothermia, etc. The LUCAS Chest Compression System plays an important role in this chain by providing high quality compressions and circulation. There are numerous studies that demonstrate the improved hemodynamics when using LUCAS (references below, summaries attached). Additionally, there is much empirical evidence from LUCAS customers who have experienced patients regain consciousness as a result of adequate blood flow provided by LUCAS – a phenomenon that is virtually unheard of with manual CPR. Finally, for complicated cases that require PCI or thrombolytics, LUCAS can be used for prolonged periods (and often in challenging environments) while physicians can treat the cause. We recognize that on its own, LUCAS may not improve outcomes, but it certainly can play a role in helping improve patients chances for a successful outcome.

Hemodynamics/ROSC:

• Liao Q, Sjoberg T, Paskevicius A, Wohlfart B, Steen S: Manual versus mechanical cardiopulmonary resuscitation. An experimental study in pigs. BMC Cardiovascular Disorders 2010; 10: 53.
• Larsen AI, Hjörnevik Å, Bonarjee V, Barvik S, Melberg T, Nilsen DW. Coronary blood flow and perfusion pressure during coronary angiography in patients with ongoing mechanical chest compression: A report on 6 cases. Resuscitation. 2010;81:493–497.
• Carmona Jimenez F, Palma Padro P, Soto Garcia A, Cadenas Martin R, Rodrigues Venegas JC, Castro Naval E . Cerebral flow improvement during CPR with LUCAS, measured by Doppler. Resuscitation. 2011. 825S1 (2011)S1-S34. Abstract AP090.
• Wagner H, Madsen Hardig B, Gotberg M, Harnek J, Olivecrona GK: Abstract 91: Aspects on Resuscitation in the Coronary Interventional Catheter Laboratory. Circulation 2010; 122(21_MeetingAbstracts): A91.
• Saussy JM, Elder JE, Flores CA, Miller AL: Abstract 256: Optimization of Cardiopulmonary Resuscitation With an Impedance Threshold Device, Automated Compression Cardiopulmonary Resuscitation and Post-Resuscitation in-the-Field Hypothermia Improves Short-term Outcomes Following Cardiac Arrest. Circulation 2010; 122: A256.
• Axelsson C, Karlsson T, Axelsson ÅB, Herlitz J. Mechanical active compression-decompression cardiopulmonary resuscitation (ACD-CPR) versus manual CPR according to pressure of end tidal carbon dioxide (PETCO2) during CPR in out-of-hospital cardiac arrest (OHCA). Resuscitation. 2009;80(10):1099-1103.

Usability/Compression ratio:

• Yost DA, Gonzales L, Lick CJ, et al.: Abstract 38: North American LUCAS Evaluation: Prehospital Use of a Mechanical Chest Compression System. Circulation 2010; 122(21_MeetingAbstracts): A38.
• Maule Y: The aid of mechanical CPR; better compressions, but more importantly - more compressions… (translated from French language; Assistance Cardiaque Externe; Masser mieux, mais surtout masser plus…). Urgence Pratique 2011; 106: 47-48.

Cath lab:

• Azadi, N, Niemann, JT, Thomas, JL. Coronary imaging and intervention during cardiovascular collapse: Use of the LUCAS mechanical CPR device in the cardiac catheterization laboratory. J INVASIVE CARDIO. 2012;24:79-83.
• Wagner H, Terkelsen, CJ, Friberg H, Harnek J, Kern K, Flensted Lassen J, Olivecrona GK. Cardiac arrest in the catheterization laboratory; a 5-year experience of using mechanical chest compressions to facilitate PCI during prolonged resuscitation efforts. Resuscitation. 2010; 383-387.

 

[Physio Control]

Lund University Hospital study

You may also be interested in this Lund University Hospital study poster:

Olson H, Rundgren M, Silverstolpe J, Friberg H. Out-of-hospital cardiac arrest—A panorama in transformation. Resuscitation. 2008;77S:S47. Poster. Improved prehospital care (including LUCAS implementation) and hospital care (implementation of hypothermia) resulted in improved 6-month outcome so that more patients survived with a better neurological outcome. http://www.lucas-cpr.com/doc_en/Olson_OHCA_and outcome_2008_p-ERC.pdf

 

[BEorP]

Thanks for the response and all of the citations. I really appreciate having a Phyiso rep on here. Those studies generally addressed things like hemodynamics, ease of use, facilitating PCI, and ROSC, but not on final outcomes. I understand that prehospital cardiac arrest research is notoriously difficult, but has there been an RCT that shows that the LUCAS improves final patient outcomes at this point? Are you aware of any RCTs currently underway? Thanks!

 

[BEorP]

I did a bit of searching and it looks like there is a big trial underway in the UK that will finally provide the evidence we need to evaluate LUCAS's impact on outcomes. For anyone else who is interested, you can read a bit about it here: http://www2.warwick.ac.uk/fac/med/research/ctu/trials/ecr/paramedic/about/

 

[Physio Control]

Thanks for the response and all of the citations. I really appreciate having a Phyiso rep on here. Those studies generally addressed things like hemodynamics, ease of use, facilitating PCI, and ROSC, but not on final outcomes. I understand that prehospital cardiac arrest research is notoriously difficult, but has there been an RCT that shows that the LUCAS improves final patient outcomes at this point? Are you aware of any RCTs currently underway? Thanks!

Thanks. We appreciate having the opportunity to join the discussion. The LINC trial is a randomized control trial currently underway in Europe (sponsored by Jolife AB). Enrollment should be finished by the end of the summer.

 

[BEorP]

Thanks. We appreciate having the opportunity to join the discussion. The LINC trial is a randomized control trial currently underway in Europe (sponsored by Jolife AB). Enrollment should be finished by the end of the summer.

Thanks for the link. Next year should be a big year for LUCAS as we hopefully start to hear the results of these trials.