Thumper/Life pak?

RescueDog

RescueDog

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Just curious what all of your opinions are on thumpers/lifepaks on cardiac arrests? Do you think they're a hassle? do you think they're helpful/useful? do you have one/want one?
 
From my experience when they work, they're an asset. The last 6 full arrests I've been on there has been a Zoll Autopulse on scene. And it has failed to work each and every time. I'm not sure why, it's not my equipment, but it always ends up sucking up a bunch of time, energy, and effort that could have been spent on just doing better compressions, etc.
 
We use a Physio LUCAS II Device on 90% of cardiac arrests. We dont have all the data extrapolated, but it certainly seems to make a difference in our ROSC rates.

As far as a lifepak, that's our standard defib/monitor.
 
That's how my department feels. We got it as an "add on" when we bought our new Zoll monitors, but it seems like no one really wants to use them. We've done trainings on them, but I'd feel terrible if we got there, tossed it on and it didn't work. I hear when it does work, it's excellent, and that there's cases of the pt. being able to 'track' the personnel.
 
DEmedic said:
As far as a lifepak, that's our standard defib/monitor.
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Ditto

It's our SOP to apply the Lucas2 within the first 5 minutes of arriving on scene (if it fits the patient). I've had experience with the Auto Pulse and was not impressed with it AT ALL! It never seemed to function properly on the 5-6 times I deployed it, something to do with the sensor I think.

There have been studies regarding the effectiveness of CPR in the back of a moving ambulance, and they are quite dismal.

http://www.jems.com/article/patient-care/merits-mechanical-cpr

When we first got the Lucas2’s, we had a few medics obtain borderline B/P’s and a notable increase in the SaO2 in full arrests.

In my opinion, their worth the hassle.
 
Each ambulance we have has a Zoll auto pulse. We have used it on all non trauma arrests with patients it fit. It has not failed to work for us.
It works very well for us.
 
Sad to say Tim is correct. We still frequently transport codes, regardless of their viability.
 
There is no conclusive data to show mechanical CPR is any better than good manual CPR. Save the $15-20,000 per device and pay for better training and development of guidelines/protocols.
 
medicsb said:
There is no conclusive data to show mechanical CPR is any better than good manual CPR. Save the $15-20,000 per device and pay for better training and development of guidelines/protocols.
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There hasn't been a large scale, randomized clinical trial of mechanical CPR devices yet. We've had inconclusive and contradictory data from several smaller trials, but we do know that it increases cardiac output and decreases hands off time after it is applied. One problem of course is application time without compressions and delayed defibrillation, but that can be minimized with training. At our agency, we've practiced rapid transition from manual CPR to mechanical and decreased hands off time to <7 seconds. That's none too shabby, and we've decided that minor delay is worth the potential benefit of continuous, high quality compressions.
 
We have had a lot of success with the use of the thumper here. I'm not sure what the difference is in positive outcomes (I'll look into that). I like it because it allows us to have shorter pauses in CPR, and we train heavily on the equipment, making sure that everyone is very competent at operating and troubleshooting the thumper before leaving orientation.
 
chaz90 said:
There hasn't been a large scale, randomized clinical trial of mechanical CPR devices yet. We've had inconclusive and contradictory data from several smaller trials, but we do know that it increases cardiac output and decreases hands off time after it is applied. One problem of course is application time without compressions and delayed defibrillation, but that can be minimized with training. At our agency, we've practiced rapid transition from manual CPR to mechanical and decreased hands off time to <7 seconds. That's none too shabby, and we've decided that minor delay is worth the potential benefit of continuous, high quality compressions.
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I suppose it depends on your definition of "large scale".

LINC (http://www.ncbi.nlm.nih.gov/pubmed/24240611) - over 2500 patients enrolled.

CIRC (http://clinicaltrials.gov/show/NCT00597207) enrolled over 4000 patients. This hasn't resulted in published results, yet, but they did make press about how they were able to match manual CPR.

ASPIRE (http://www.ncbi.nlm.nih.gov/pubmed/16772625) enrolled over 1000.

Nothing yet showing better outcomes. All 3 are RCTs.
 
medicsb said:
There is no conclusive data to show mechanical CPR is any better than good manual CPR. Save the $15-20,000 per device and pay for better training and development of guidelines/protocols.
Click to expand...
Good manual CPR can get tiring and quality can suffer if you don't have enough people on scene.
 
Our Lucas frees up at LEAST one set of hands, technically two. We depend heavily on our volley EMRs on scene during arrests for their CPR. Even having them freed up to do other things is helpful. Medics do meds, EMTs do IVs and lead placement, EMR can insert an airway and bag.

We're really lucky.. We're lucky that our EMT's are all varianced and trained to A level, and our EMRs have deep protocols compared to most. Hopefully in the next 6 months all our Nine-Lines will have thumpers too.

Life Paks are our standard.
 
Yeah, I hear mixed things. Example; auto pulse tends to have really finicky sensors, and thus will stop CPR because it'll assume the patient is moving. I was also on an arrest where the thumper, I believe, was used. they set it up to compress in the incorrect location. I guess they both have their downfalls. some people are just super against them, and others rely on them, I guess it depends on the department and manpower.
 
RescueDog said:
Yeah, I hear mixed things. Example; auto pulse tends to have really finicky sensors, and thus will stop CPR because it'll assume the patient is moving. I was also on an arrest where the thumper, I believe, was used. they set it up to compress in the incorrect location. I guess they both have their downfalls. some people are just super against them, and others rely on them, I guess it depends on the department and manpower.
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... And training. We can rapid deploy the LUCAS, less than 20 seconds to place and start it. We run codes with continuous compressions, and have had good success with ROSC.
 
The Auto Pulse is the only one I've had experience with, and it works alright. Seems that it works better on bigger patients though, the skinny ones seem like they move around a bit and it shuts off.
 
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